Tricuspid valve repair concomitant with the Norwood operation among babies with hypoplastic left heart syndrome

OBJECTIVES: Among patients with hypoplastic left heart syndrome (HLHS), tricuspid valve regurgitation (TR) portends a poor prognosis. Our goal was to describe the outcomes of tricuspid valve reconstruction (TVR) concomitant with the Norwood operation and using twodimensional echocardiography and evaluate the structural factors associated with successful functional correction. METHODS: We performed a retrospective, single-centre study of patients with HLHS undergoing TVR at the time of the Norwood operation. Structural echocardiographic parameters were compared between patients with successful correction (<= mild TR) and those with >= moderate regurgitation at discharge. Preoperative dimensions of matched HLHS controls with <= trivial TR were used as a reference. RESULTS: Of 205 patients with HLHS undergoing the Norwood operation, 18 patients had a concomitant TVR. Ten (56%) patients had an improved TR grade postoperatively, 8 (44%) of whom had <= mild TR at discharge. Improvement in TR grade (P=0.001) and having <= mild TR at discharge (P = 0.011) were associated with an improved reintervention and TR-free survival. Patients with successful functional correction had smaller preoperative tricuspid annulus lateral dimensions (P = 0.023), tricuspid valve area (P = 0.007) and right ventricle midwidth (P = 0.064). Preoperatively, the successful TVR cases tended to have had higher anterior leaflet excursion (80 +/- 20 vs 55 +/- 11, P= 0.010), and a higher proportion of anterior leaflet prolapse (63% vs 10%, P= 0.043) compared to cases where TVR was not successful. CONCLUSIONS: Patients with HLHS with significant tricuspid regurgitation undergoing the stage 1 operation were more likely to have successful concomitant tricuspid valve repair if they had less tricuspid annular dilation, less-severe RV enlargement and predominantly anterior leaflet prolapse. Successful tricuspid valve repair was associated with improved mid- and long-term outcomes.