The long-term impact of the tricuspid valve intervention after Fontan completion

BACKGROUND: The incompetence of the tricuspid valve (TV) may predispose to unfavorable results of Fontan palliation in patients with single right ventricle (RV). This study aims to reveal the effect of TV intervention in patients with single RV on long-term outcomes after Fontan completion. METHODS: A single-center retrospective cohort study was conducted with patients who underwent Fontan completion from 1985 to 2017. There was a total of 678 patients with single RV. A total of 128 patients (18.8%) underwent TV intervention at any stage (TVI group); 30 of them (23.4%) underwent repeat TV surgery (repeat TVI subgroup). The control group comprises 550 patients (81.2%) who had no TV surgery regardless of the degree of TR (non TVI group). RESULTS: The median follow-up was 8.8 (± 7.6) years. Overall transplant- and Fontan takedown-free survival was 62.5% (95% CI 59.2%-64.9%) at 20 years. The repeat TVI group had significantly lower transplant and takedown-free survival rates (Non TVI 76.5% vs. Single TVI 75.3% vs. repeat TVI 56.0% at 15 years, P = 0.02). The younger age at Fontan (1.12 [95% CI 1.02-1.22], p = 0.019), repeat TVI (3.33 [95% CI 1.57-7.04], p = 0.002), TV intervention after Fontan (6.14 [95% CI 2.60-14.50], p < 0.001), significant ventricular dysfunction before Fontan (3.12 [95% CI 1.12-8.30], p = 0.028) and any concomitant procedure at Fontan (1.98 [95% CI 1.16-3.37], p = 0.013) were the significant risk factors for transplant and takedown free- survival. CONCLUSIONS: Repeat TV intervention during the Fontan was associated with inferior outcomesin patients with morphologic systemic RV. Successful TV intervention could provide comparable long-term survival outcomes to non-TV intervention patients.