• Catherine Deshaies, Helen Trottier, Paul Khairy, Mohammed Al-Aklabi, Luc Beauchesne, Pierre-Luc Bernier, Santokh Dhillon, Sanjiv K Gandhi, Christoph Haller, Camille L Hancock Friesen, Edward J Hickey, David Horne, Frédéric Jacques, Marla C Kiess, Jean Perron, Maria Rodriguez, Nancy C Poirier, and Canadian Congenital Cardiac Collaborative (4C).
• Queen Elizabeth II Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada; Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Centre hospitalier universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada. Electronic address: catherine.deshaies@mail.mcgill.ca.
• J. Am. Coll. Cardiol. 2020 Mar 10; 75 (9): 1033-1043.

BackgroundTricuspid regurgitation (TR) is common among adults with corrected tetralogy of Fallot (TOF) or pulmonary stenosis (PS) referred for pulmonary valve replacement (PVR). Yet, combined valve surgery remains controversial.ObjectivesThis study sought to evaluate the impact of concomitant tricuspid valve intervention (TVI) on post-operative TR, length of hospital stay, and on a composite endpoint consisting of 7 early adverse events (death, reintervention, cardiac electronic device implantation, infection, thromboembolic event, hemodialysis, and readmission).MethodsThe national Canadian cohort enrolled 542 patients with TOF or PS and mild to severe TR who underwent isolated PVR (66.8%) or PVR+TVI (33.2%). Outcomes were abstracted from charts and compared between groups using multivariable logistic and negative binomial regression.ResultsMedian age at reintervention was 35.3 years. Regardless of surgery type, TR decreased by at least 1 echocardiographic grade in 35.4%, 66.9%, and 92.8% of patients with pre-operative mild, moderate, and severe insufficiency. In multivariable analyses, PVR+TVI was associated with an additional 2.3-fold reduction in TR grade (odds ratio [OR]: 0.44; 95% confidence interval [CI]: 0.25 to 0.77) without an increase in early adverse events (OR: 0.85; 95% CI: 0.46 to 1.57) or hospitalization time (incidence rate ratio: 1.17; 95% CI: 0.93 to 1.46). Pre-operative TR severity and presence of transvalvular leads independently predicted post-operative TR. In contrast, early adverse events were strongly associated with atrial tachyarrhythmia, extracardiac arteriopathy, and a high body mass index.ConclusionsIn patients with TOF or PS and significant TR, concomitant TVI is safe and results in better early tricuspid valve competence than isolated PVR.Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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