Role of tricuspid valve repair in pulmonary atresia with intact ventricular septum: fresh autologous pericardium as a viable option

OBJECTIVES: This study aimed to evaluate the surgical outcomes of tricuspid valve (TV) leaflet augmentation using fresh autologous pericardium (FAP) in patients with pulmonary atresia with intact ventricular septum (PA-IVS). METHODS: Nine patients with PA-IVS underwent TV leaflet augmentation (TVLA) using FAP between January 2017 and April 2024. Native TV failure was defined as significant (≥moderate) tricuspid regurgitation and/or stenosis (mean pressure gradient >5 mmHg). Clinical outcomes, including both TV and right ventricle (RV) size and functions, were evaluated using echocardiography and magnetic resonance imaging. RESULTS: The median age and body weight at the time of surgery were 5.4 years and 21.2 kg, respectively. No operative mortality occurred. During the follow-up period, no late mortalities, reoperations or significant TV leaflet-related complications were observed; native TV failure was not observed in any patients, except one with significant tricuspid regurgitation. Biventricular repair was performed in all patients except one who had undergone preoperative one-and-a-half ventricle repair. After TVLA using FAP, the median TV annulus z-score remained within the normal ranges (preoperative -0.42 [-0.62 to 0.57] versus postoperative -0.51 [-0.95 to -0.13], mean difference: 0.231, 95% confidence interval: -0.338 to 0.800, P = 0.377) and tricuspid regurgitation improved significantly (mean difference: 2.111, 95% confidence interval: 1.510-2.712, P = 0.040). Postoperative magnetic resonance imaging showed that RV function, and cardiac output were preserved within acceptable ranges. CONCLUSIONS: TVLA using FAP could be a considerable and viable approach to optimize RV growth while preserving RV and TV functions in the long-term in young patients with PA-IVS.