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Tricuspid Valve Surgery For Non-ebstein Congenital Diseases: Indications, Outcomes And Prognostic Factors In The Modern Era
David Kalfa, Eliana Al Haddad, Kanwal Farooqi, Amee Shah, Damien La, LaPar, Brett Anderson, Emile Bacha.
Columbia University Medical Center, New York, NY, USA.

Objectives: Little data currently exists depicting the surgical indications, outcomes and prognostic factors for patients with non-Ebstein congenital tricuspid valve(TV) lesions. Our aim is to describe surgical indications, outcomes and prognostic factors for patients with non-Ebstein congenital TV lesions in our center in the modern era.
Methods: 149 patients underwent TV surgery for non-Ebstein congenital TV disease between 2006-2018. Univariate and Kaplan-Meier analyses evaluated operative and long-term outcomes. Results: Surgery was a TV repair in 103(69%) and TV replacement in 46(31%) patients. Patient characteristics and outcomes are presented in the Table. Long-term follow-up was 100%(mean 33yr, range <1-12yr). Kaplan-Meier long-term freedom from reintervention was 98%, 89% and 58% at 1, 5 and 10 years, respectively, while survival was 98%, 96% and 93% at 1, 5, and 10 years, respectively. Single-ventricle associated TV diseases(p=0.04), younger age at surgery(p=0.029) and previous cardiac surgeries and interventions(p=0.01) were associated with a higher risk of in hospital death. Younger age at surgery was also associated with a higher risk of recurrent TR at last follow-up(p=0.027).
Conclusions: TV surgery in non-Ebstein congenital patients yields excellent outcomes. Single-ventricle associated TV diseases and younger age at surgery are associated with a higher risk of in hospital death. TV Replacement is not a risk factor for death or reoperation. Repair is not a risk factor for residual or recurrent TV lesion.

TV Repair Group(N=103)TV Replacement Group(N=46)P-ValuePatients<18 Years(N=63)Patient≥18 Years(N=86)P-Value
Age22.7 (21.7)37.3 (19.7)0.4615.2 (5.6)43.3 (14.6)0.461
LesionTV regurgitationTV stenosisMixed TR+TS94 (91.3%)5 (4.9%)3 (2.9%)42 (91.3%)2 (4.3%)2 (4.3%)0.90154 (85.7%)5 (7.9%)3 (4.8%)82 (95.3%)2 (2.3%)2 (2.3%)0.178
EtiologyTV DysplasiaIatrogenicTR/Single VentricleTOFOther5 (4.9%)27 (26.2%)33 (32 %)14 (13.6%)11 (10.7%)3 (6.5%)15 (32.6%)10 (21.7%)5 (10.9%)8 (17.4%)0.5466 (9.5%)13 (20.6%)22 (34.9%)5 (7.9%)8 (12.7%)2 (2.3%)29 (33.7%)21 (24.4%)14 (16.3%)11 (12.8%)0.059
Reintervention for TV during the same adnission3 (3%)1 (2.2%)0.7713 (4.8%)1 (1.2%)0.200
Early mortality3 (3%)1 (2.2%)0.6334 (6.3%)0 (0%)0.029
Recurrent TV insufficiency (≥2) at last follow-up10 (9.7%)2 (4.3%)0.1238 (12.7%)4 (4.7%)0.027
Re-intervention for TV at last follow-up6 (5.8%)5 (10.9%)0.3097 (11.1%)4 (4.7%)0.070
Late mortality4 (4%)3 (6.5%)0.3725 (7.9%)2 (2.3%)0.114


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