Tricuspid valve replacement provides better long-term survival and tricuspid valve function than repair in patients with systemic right ventricle

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  TVR provided better long-term outcomes than valvuloplasty.

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  Figure 1. Surgical intervention flow chart. The proportion of d-TGA and l-TGA patients was similar in both groups. The most frequent reason for TR was abnormal cusp or chordae in the TVP group and annular dilatation in the TVR group. Tricuspid valve–related reoperations were performed in 4 patients. There was 1 early mortality and 4 late mortalities in this study. TVP, Tricuspid valvuloplasty; TVR, tricuspid valve replacement; TGA, transposition of the great arteries; TR, tricuspid regurgitation.

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  Figure 2. Comparison of TVP and TVR. Comparison of TVP (blue line) and TVR (red line) showing overall survival (A), cumulative incidence of tricuspid valve dysfunction (B), and cumulative incidence of tricuspid valve-related reoperation (C). A, The overall survival was 72.7% ± 13.4% (95% CI, 37.1%-90.3%) at 10 to 20 years after tricuspid surgery and 54.6% ± 18.7% (95% CI, 16.0%-81.9%) at 25 years in the TVP group, whereas that was 94.7% ± 5.1% (95% CI, 68.1%-99.2%) at 10 to 25 years in the TVR group (P = .0285). B, The cumulative incidence of tricuspid valve dysfunction was 27.3% (95% CI, 6.5%-53.9%) at 10 years after tricuspid surgery, 38.2% (95% CI, 11.5%-65.2%) at 20 years, and 52.7% (95% CI, 18.1%-78.7%) at 22 years in the TVP group, whereas that was 0% at 10 to 15 years and 18.9% (95% CI, 0.8%-56.1%) at 20 years in the TVR group. There were significant differences between the groups (P = .0121). C, The cumulative incidence of tricuspid valve–related reoperation was 18.2% (95% CI, 6.5%-53.9%) at 10 to 22 years after tricuspid surgery and 42.0% (95% CI, 7.4%-74.9%) at 23 years in the TVP group, whereas that was 0% at 10 to 15 years and 18.9% (95% CI, 0.8%-56.1%) at 20 years in the TVR…

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  Figure 3. Comparison of d-TGA (blue line) and l-TGA (red line) showing overall survival. The overall survival was 76.2% ± 14.8% (95% CI, 33.2%-93.5%) at 10 to 22 years after tricuspid surgery in the d-TGA group, whereas that was 92.0% ± 5.4% (95% CI, 71.6%-97.9%) at 10 to 20 years and 76.7% ± 14.7% (95% CI, 33.5%-93.8%) at 25 years in the l-TGA group (P = .3107). TGA, Transposition of the great arteries; d-TGA, dextro-transposition of the great arteries; l-TGA, levo-transposition of the great arteries.

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  Figure 4. Summary of the study. A total of 34 patients with d-TGA or l-TGA with biventricular circulation and systemic RV were divided into 2 groups based on the tricuspid procedure: TVP (n = 11) and TVR (n = 23). There were significant differences between the groups in survival and freedom from tricuspid valve dysfunction. TVP, Tricuspid valvuloplasty; TVR, tricuspid valve replacement; d-TGA, dextro-transposition of the great arteries; l-TGA, levo-transposition of the great arteries.

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  Figure E1. Comparison of d-TGA (blue line) and l-TGA (red line) showing (A) cumulative incidence of tricuspid dysfunction and (B) cumulative incidence of tricuspid valve–related reoperation. A, The cumulative incidence of tricuspid dysfunction was 11.1% (95% CI, 0.6%-38.8%) at 10 to 20 years after tricuspid surgery in the d-TGA group, whereas that was 8.0% (95% CI, 1.4%-22.5%) at 10 to 15 years after tricuspid surgery, 27.6% (95% CI, 7.2%-53.2%) at 20 years, and 54.9% (95% CI, 19.2%-80.5%) at 25 years in the l-TGA group. There were no significant differences between the groups (P = .7650). B, The cumulative incidence of tricuspid valve–related reoperation was 11.1% (95% CI, 0.6%-38.8%) at 10 to 20 years after tricuspid surgery in the d-TGA group, whereas that was 4.0% (95% CI, 0.3%-17.0%) at 15 years after tricuspid surgery, 13.2% (95% CI, 1.8%-36.3%) at 20 years, and 27.0% (95% CI, 5.0%-56.3%) at 25 years in the l-TGA group. There were no significant differences between the groups (P = .6346). TGA, Transposition of the great arteries; d-TGA, dextro-transposition of the great arteries; l-TGA, levo-transposition of the great arteries.