Mechanical tricuspid valve replacement in hypoplastic left heart syndrome: An institutional experienceCentral MessagePerspective
Objective: Atrioventricular valvar regurgitation in patients with single ventricles is associated with worse outcomes. Valve repair or replacement has been undertaken in an attempt to reduce mortality and morbidity. Current data on valve replacement in single ventricle patients are limited and deriv...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273622002868 |
| _version_ | 1811266144379600896 |
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| author | Mehar Hoda, MD Robert Douglas Benjamin Jaquiss, MD Lorraine James, MD Poonam Punjwani Thankavel, MD |
| author_facet | Mehar Hoda, MD Robert Douglas Benjamin Jaquiss, MD Lorraine James, MD Poonam Punjwani Thankavel, MD |
| author_sort | Mehar Hoda, MD |
| collection | DOAJ |
| description | Objective: Atrioventricular valvar regurgitation in patients with single ventricles is associated with worse outcomes. Valve repair or replacement has been undertaken in an attempt to reduce mortality and morbidity. Current data on valve replacement in single ventricle patients are limited and derived from heterogenous populations. We describe our experience with repair and replacement of the tricuspid valve in children undergoing single ventricle palliation for hypoplastic left heart syndrome. Methods: We included 27 patients with hypoplastic left heart syndrome with at least moderate tricuspid regurgitation who underwent valve intervention between 2007 and 2021 at our institution; charts were retrospectively reviewed for data. Results: Eleven patients (73% male) underwent valve replacement (median age, 3 years). Preoperative ventricular systolic function was normal in 10 patients (91%). Median follow-up postoperatively was 4 years with no early mortality, 1 (9%) late mortality, and 1 heart transplant (9%). Morbidity consisted of complete heart block in 1 patient (9%), with no important hemorrhagic or thrombotic events. Among survivors of replacement (n = 9), ventricular function was preserved in all (n = 8) who had normal function preoperatively and improved in the remaining patient. Sixteen patients underwent valve repair (median age, 4 months) with no early mortality, 8 (50%) midterm mortalities, and 2 heart transplants (12%). Conclusions: Tricuspid valve replacement is a feasible option in hypoplastic left heart syndrome with significant tricuspid regurgitation, with favorable outcomes in the intermediate follow-up. When undertaken in the setting of normal function, ventricular function may be preserved in up to 80% of patients. Long-term follow-up is needed. |
| first_indexed | 2024-04-12T20:37:53Z |
| format | Article |
| id | doaj.art-1642b302d6b34816bf90f16915aecafa |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-04-12T20:37:53Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-1642b302d6b34816bf90f16915aecafa2022-12-22T03:17:32ZengElsevierJTCVS Open2666-27362022-09-0111363372Mechanical tricuspid valve replacement in hypoplastic left heart syndrome: An institutional experienceCentral MessagePerspectiveMehar Hoda, MD0Robert Douglas Benjamin Jaquiss, MD1Lorraine James, MD2Poonam Punjwani Thankavel, MD3Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern, Dallas, Tex; Address for reprints: Mehar Hoda, MD, Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390.Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern, Dallas, TexDivision of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern, Dallas, Tex; Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern, Dallas, Tex; Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif; Division of Congenital Heart Surgery, Department of Pediatrics, Medical City Children's Hospital Congenital Heart Center, Dallas, TexDivision of Congenital Heart Surgery, Department of Pediatrics, Medical City Children's Hospital Congenital Heart Center, Dallas, TexObjective: Atrioventricular valvar regurgitation in patients with single ventricles is associated with worse outcomes. Valve repair or replacement has been undertaken in an attempt to reduce mortality and morbidity. Current data on valve replacement in single ventricle patients are limited and derived from heterogenous populations. We describe our experience with repair and replacement of the tricuspid valve in children undergoing single ventricle palliation for hypoplastic left heart syndrome. Methods: We included 27 patients with hypoplastic left heart syndrome with at least moderate tricuspid regurgitation who underwent valve intervention between 2007 and 2021 at our institution; charts were retrospectively reviewed for data. Results: Eleven patients (73% male) underwent valve replacement (median age, 3 years). Preoperative ventricular systolic function was normal in 10 patients (91%). Median follow-up postoperatively was 4 years with no early mortality, 1 (9%) late mortality, and 1 heart transplant (9%). Morbidity consisted of complete heart block in 1 patient (9%), with no important hemorrhagic or thrombotic events. Among survivors of replacement (n = 9), ventricular function was preserved in all (n = 8) who had normal function preoperatively and improved in the remaining patient. Sixteen patients underwent valve repair (median age, 4 months) with no early mortality, 8 (50%) midterm mortalities, and 2 heart transplants (12%). Conclusions: Tricuspid valve replacement is a feasible option in hypoplastic left heart syndrome with significant tricuspid regurgitation, with favorable outcomes in the intermediate follow-up. When undertaken in the setting of normal function, ventricular function may be preserved in up to 80% of patients. Long-term follow-up is needed.http://www.sciencedirect.com/science/article/pii/S2666273622002868anticoagulationhypoplastic left heart syndromesingle ventricletricuspid regurgitationvalve replacement |
| spellingShingle | Mehar Hoda, MD Robert Douglas Benjamin Jaquiss, MD Lorraine James, MD Poonam Punjwani Thankavel, MD Mechanical tricuspid valve replacement in hypoplastic left heart syndrome: An institutional experienceCentral MessagePerspective JTCVS Open anticoagulation hypoplastic left heart syndrome single ventricle tricuspid regurgitation valve replacement |
| title | Mechanical tricuspid valve replacement in hypoplastic left heart syndrome: An institutional experienceCentral MessagePerspective |
| title_full | Mechanical tricuspid valve replacement in hypoplastic left heart syndrome: An institutional experienceCentral MessagePerspective |
| title_fullStr | Mechanical tricuspid valve replacement in hypoplastic left heart syndrome: An institutional experienceCentral MessagePerspective |
| title_full_unstemmed | Mechanical tricuspid valve replacement in hypoplastic left heart syndrome: An institutional experienceCentral MessagePerspective |
| title_short | Mechanical tricuspid valve replacement in hypoplastic left heart syndrome: An institutional experienceCentral MessagePerspective |
| title_sort | mechanical tricuspid valve replacement in hypoplastic left heart syndrome an institutional experiencecentral messageperspective |
| topic | anticoagulation hypoplastic left heart syndrome single ventricle tricuspid regurgitation valve replacement |
| url | http://www.sciencedirect.com/science/article/pii/S2666273622002868 |
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