Work

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

Year: 2026

Type: article

Abstract: 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: = .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.

Source: JTCVS Open

DOI: 10.1016/j.xjon.2026.102070