Risk factors and outcomes of tricuspid valve surgery in hypoplastic left heart syndrome patients with tricuspid regurgitation.

@article{cordoves2026risk,
  title = {{Risk factors and outcomes of tricuspid valve surgery in hypoplastic left heart syndrome patients with tricuspid regurgitation.}},
  author = {Elizabeth M Cordoves and Gerardo Ramos-Lemos and Vincent R LaSala and Halil Beqaj and Paul Trackey and Andrew B Goldstone and Stephanie Levasseur and Amee Shah and Ganga Krishnamurthy and Emile A Bacha and David M Kalfa},
  journal = {JTCVS open},
  year = {2026},
  month = aug,
  doi = {10.1016/j.xjon.2026.102070},
  url = {https://europepmc.org/article/MED/42948216},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - Risk factors and outcomes of tricuspid valve surgery in hypoplastic left heart syndrome patients with tricuspid regurgitation.
AU  - Elizabeth M Cordoves
AU  - Gerardo Ramos-Lemos
AU  - Vincent R LaSala
AU  - Halil Beqaj
AU  - Paul Trackey
AU  - Andrew B Goldstone
AU  - Stephanie Levasseur
AU  - Amee Shah
AU  - Ganga Krishnamurthy
AU  - Emile A Bacha
AU  - David M Kalfa
PY  - 2026
DA  - 2026/08/21
JO  - JTCVS open
DO  - 10.1016/j.xjon.2026.102070
UR  - https://europepmc.org/article/MED/42948216
AB  - Objective  The management of patients with hypoplastic left heart syndrome with tricuspid regurgitation remains controversial. We evaluate risk factors for mortality/transplant/Fontan takedown in patients with hypoplastic left heart syndrome with tricuspid regurgitation and the effect of tricuspid valve surgery on clinical trajectories.Methods  A retrospective chart review was performed for all hypoplastic left heart syndrome primary surgical Norwood recipients at our center who had moderate or greater tricuspid regurgitation (2006-2023). Freedom from a primary outcome of combined mortality/transplant/Fontan takedown was compared between those who underwent tricuspid valve surgery (N = 30, 67%) and those who did not (N = 15, 33%; Cox regression, log-rank). Among those who developed tricuspid regurgitation anytime post-Norwood (N = 37), tricuspid valve repair efficacy was assessed (Wilcoxon signed-rank, McNemar's test). Cumulative incidence of recurrent tricuspid regurgitation and right ventricle dysfunction was estimated (Aalen-Johansen estimator, death/transplant as competing risks).Results  Patients with pre-Norwood tricuspid regurgitation experienced a mortality-dominated trajectory (5-year freedom from mortality 37.5%), whereas patients with post-Norwood/pre-Glenn tricuspid regurgitation experienced a transplant-dominated trajectory (5-year freedom from mortality 88.5%, composite outcome 55.9%). On univariable Cox regression, pre-Norwood right ventricle dysfunction (hazard ratio, 9.75, P < .001) was associated with the primary outcome; pre-Norwood tricuspid regurgitation tended toward association (hazard ratio, 2.40, P = .10). On multivariable analysis, pre-Norwood right ventricle dysfunction (hazard ratio, 12.79 [3.16-51.80], P < .001) and pre-Norwood tricuspid regurgitation (hazard ratio, 3.10 [1.03-9.31], P = .04) were both independently associated with the primary outcome. Among those with post-Norwood tricuspid regurgitation who underwent tricuspid valve surgery, tricuspid regurgitation severity decreased, with 43% achieving preserved freedom from moderate or greater tricuspid regurgitation.Conclusions  Pre-Norwood right ventricle dysfunction and pre-Norwood tricuspid regurgitation were found to be associated with the primary outcome. In those with post-Norwood tricuspid regurgitation, tricuspid valve repair reduced tricuspid regurgitation but was not associated with improved survival.
SN  - 2666-2736
ER  -