Long-term outcome and risk factor analysis of tricuspid valve replacement for adult patients with congenitally corrected transposition of great arteries_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Qi , DENG Long , XU Jianping , SUN Hansong , LIU Sheng ,  SONG Yunhu

Department of Adult Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;

Corresponding author：

SONG Yunhu, Email: song_tiger@foxmail.com

Keywords：

Tricuspid valve replacement; congenital heart diseases; corrected transposition of the great artery

DOI：

10.7507/1007-4848.201811072

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Objective To evaluate the long-term clinical effect and risk factors of tricuspid valve replacement (TVR) as a relief treatment for adult patients with congenitally corrected transposition of the great artery (CCTGA).Method We retrospectively analyzed the clinical data of 47 adult patients with CCTGA who underwent tricuspid valve replacement in Fuwai Hospital between 2000 and 2017 year. There were 27 males and 20 females with operation age of 14–62 (38.8±13.5) years. Preoperative echocardiography showed moderate or more tricuspid regurgitation in all patients. The basic data of patients before and during operation were recorded. Survival was followed up by telephone and ultrasound report.Results The average follow-up time was 6.5±3.7 years. The 1-year, 5-year and 10-year survival rate or the incidence of heart transplant-free was 94.6%, 90.5% and 61.7%, respectively. During the follow-up period, the long-term right ventricular ejection fraction of most patients (>90%) was still greater than or equal to 40%. Increased preoperative right ventricular end diastolic diameter (RVEDD) was a risk factor for death or heart transplantation (risk ratio 1∶11, P=0.04). The survival rate of patients with RVEDD (>60 mm) before operation was significantly reduced (P=0.032).Conclusion TVP is a feasible treatment for adult patients with CCTGA. The increase of preoperative RVEDD is a risk factor for long-term mortality.

Citation： LI Qi, DENG Long, XU Jianping, SUN Hansong, LIU Sheng, SONG Yunhu. Long-term outcome and risk factor analysis of tricuspid valve replacement for adult patients with congenitally corrected transposition of great arteries. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(9): 884-888. doi: 10.7507/1007-4848.201811072 Copy

1.	Dimas AP, Moodie DS, Sterba R, et al. Long-term function of the morphologic right ventricle in adult patients with corrected transposition of the great arteries. Am Heart J, 1989, 118: 526-530.
2.	Dobson R, Danton M, Nicola W, et al. The natural and unnatural history of the systemic right ventricle in adult survivors. J Thorac Cardiovasc Surg, 2013, 145: 1493-1501.
3.	Graham TP Jr, Bernard YD, Mellen BG, et al. Long-term outcome in congenitally corrected transposition of the great arteries: a multi-institutional study. J Am Coll Cardiol, 2000, 36: 255-261.
4.	Ikeda U, Furuse M, Suzuki O, et al. Long-term survival in aged patients with corrected transposition of the great arteries. Chest, 1992, 101: 1382-1385.
5.	Presbitero P, Somerville J, Rabajoli F, et al. Corrected transposition of the great arteries without associated defects in adult patients: clinical pro?le and follow up. Br Heart J, 1995, 74: 57-59.
6.	Jonas RA. Comprehensive Surgical Management of Congenital Heart Disease, 2nd ed. Boca Raton, FL: CRC, 2014: 636-637.
7.	Kouchoukos NT, Blackstone EH, Hanley FL, et al Cardiac Surgery, 4^thed. Philadelphia, PA: Saunders, 2012: 1994-1995.
8.	Voskuil M, Hazekamp MG, Kroft LJ, et al. Postsurgical course of patients with congenitally corrected transposition of the great arteries. Am J Cardiol, 1999, 83: 558-562.
9.	Warnes CA. Transposition of the great arteries. Circulation, 2006, 114: 26992709.
10.	Prieto LR, Hordof AJ, Secic M, et al. Progressive tricuspid valve disease in patients with congenitally corrected transposition of the great arteries. Circulation, 1998, 98: 997-1005.
11.	Kral Kollars CA, Gelehrter S, Bove EL, et al. Effects of morphologic left ventricular pressure on right ventricular geometry and tricuspid valve regurgitation in patients with congenitally corrected transposition of the great arteries. Am J Cardiol, 2010, 105: 735-739.
12.	Scherptong RW, Vliegen HW, Winter MM, et al. Tricuspid valve surgery in adults with a dysfunctional systemic right ventricle: repair or replace? Circulation, 2009, 119: 1467-1472.
13.	Rutledge JM, Nihill MR, Fraser CD, et al. Outcome of 121 patients with congenitally corrected transposition of the great arteries. Pediatr Cardiol, 2002, 23: 137-145.
14.	Dodge-Khatami A, Kadner A, Berger MDF, et al. In the footsteps of senning: lessons learned from atrial repair of transposition of the great arteries. Ann Thorac Surg, 2005, 79: 1433-1444.
15.	Hraska V, Duncan BW, Mayer JE Jr, et al. Long-term outcome of surgically treated patients with corrected transposition of the great arteries. J Thorac Cardiovasc Surg, 2005, 129: 182-191.
16.	Mongeon FP, Connolly HM, Dearani JA, et al. Congenitally corrected transposition of the great arteries ventricular function at the time of systemic atrioventricular valve replacement predicts long-term ventricular function. J Am Coll Cardiol, 2011, 57: 2008-2017.
17.	van Son JA, Danielson GK, Huhta JC, et al. Late results of systemic atrioventricular valve replacement in corrected transposition. J Thorac Cardiovasc Surg, 1995, 109: 642-652.
18.	Koolbergen DR, Ahmed Y, Bouma BJ, et al. Follow-up after tricuspid valve surgery in adult patients with systemic right ventricles. Eur J Cardiothorac Surg, 2016, 50: 456-463.
19.	Acar P, Sidi D, Bonnet D, et al. Maintaining tricuspid valve competence in double discordance: a challenge for the paediatric cardiologist. Heart, 1998, 80: 479-483.
20.	Talwar S, Ahmed T, Saxena A, et al. Morphology, surgical techniques, and outcomes in patients above 15 years undergoing surgery for congenitally corrected transposition of great arteries. World J Pediatr Congenit Heart Surg, 2013, 4: 271-277.
21.	Benson LN, Burns R, Schwaiger M, et al. Radionuclide angiographic evaluation of ventricular function in isolated congenitally corrected transposition of the great arteries. Am J Cardiol, 1986, 58: 319-324.
22.	Lim HG, Lee JR, Kim YJ, et al. Outcomes of biventricular repair for congenitally corrected transposition of the great arteries. Ann Thorac Surg, 2010, 89: 159-167.
23.	Devaney EJ, Charpie JR, Ohye RG, et al. Combined arterial switch and senning operation for congenitally corrected transposition of the great arteries: patient selection and intermediate results. J Thorac Cardiovasc Surg, 2003, 125: 500-507.
24.	Poirier NC, Yu JH, Brizard CP, et al. Long-term results of left ventricular reconditioning and anatomic correction for systemic right ventricular dysfunction after atrial switch procedures. J Thorac Cardiovasc Surg, 2004, 127: 975-981.
25.	Bove EL, Ohye RG, Devaney EJ, et al. Anatomic correction of congenitally corrected transposition and its close cousins. Cardiol Young, 2006, 16(Suppl 3): 85-90.
26.	Duncan BW, Mee RB. Management of the failing systemic right ventricle. Semin Thorac Cardiovasc Surg, 2005, 17: 160-169.
27.	Mee RB. Severe right ventricular failure after mustard or senning operation. Two-stage repair: pulmonary artery banding and switch. J Thorac Cardiovasc Surg, 1986, 92: 385-390.
28.	Winlaw DS, McGuirk SP, Balmer C, et al. Intention-to-treat analysis of pulmonary artery banding in conditions with a morphological right ventricle in the systemic circulation with a view to anatomic biventricular repair. Circulation, 2005, 111: 405-411.
29.	Wilkinson JL, Smith A, Lincoln C, et al. Conducting tissues in congenitally corrected transposition with situs inversus. Br Heart J, 1978, 40: 41-48.
30.	Anderson RH, Becker AE, Arnold R, et al. The conducting tissues in congenitally corrected transposition. Circulation, 1974, 50: 911-923.
31.	Pettersen E, Helle-Valle T, Edvardsen T, et al. Contraction pattern of log-rank the systemic right ventricle shift from longitudinal to circumferential shortening and absent global ventricular torsion. J Am Coll Cardiol, 2007, 49: 2450-2456.
32.	Hornung TS, Bernard EJ, Celermajer DS, et al. Right ventricular dysfunction in congenitally corrected transposition of the great arteries. Am J Cardiol, 1999, 84: 1116-1119, A1110.
33.	Hauser M, Bengel FM, Hager A, et al. Impaired myocardial blood flow and coronary flow reserve of the anatomical right systemic congenitally corrected transposition of ventricle the great in patients with arteries. Heart, 2003, 89: 1231-1235.
34.	Hauser M, Meierhofer C, Schwaiger M, et al. Myocardial blood flow in patients with transposition of the great arteries—risk factor for dysfunction of the morphologic systemic right ventricle late after atrial repair. Circ J, 2015, 79: 425-431.
35.	Hornung TS, Bernard EJ, Jaeggi ET, et al. Myocardial perfusion defects and associated systemic ventricular dysfunction in congenitally corrected transposition of the great arteries. Heart, 1998, 80: 322-326.
36.	Huhta JC, Maloney JD, Ritter DG, et al. Complete atrioventricular block in patients with atrioventricular discordance. Circulation, 1983, 67: 1374-1377.

1. Dimas AP, Moodie DS, Sterba R, et al. Long-term function of the morphologic right ventricle in adult patients with corrected transposition of the great arteries. Am Heart J, 1989, 118: 526-530.
2. Dobson R, Danton M, Nicola W, et al. The natural and unnatural history of the systemic right ventricle in adult survivors. J Thorac Cardiovasc Surg, 2013, 145: 1493-1501.
3. Graham TP Jr, Bernard YD, Mellen BG, et al. Long-term outcome in congenitally corrected transposition of the great arteries: a multi-institutional study. J Am Coll Cardiol, 2000, 36: 255-261.
4. Ikeda U, Furuse M, Suzuki O, et al. Long-term survival in aged patients with corrected transposition of the great arteries. Chest, 1992, 101: 1382-1385.
5. Presbitero P, Somerville J, Rabajoli F, et al. Corrected transposition of the great arteries without associated defects in adult patients: clinical pro?le and follow up. Br Heart J, 1995, 74: 57-59.
6. Jonas RA. Comprehensive Surgical Management of Congenital Heart Disease, 2nd ed. Boca Raton, FL: CRC, 2014: 636-637.
7. Kouchoukos NT, Blackstone EH, Hanley FL, et al Cardiac Surgery, 4^thed. Philadelphia, PA: Saunders, 2012: 1994-1995.
8. Voskuil M, Hazekamp MG, Kroft LJ, et al. Postsurgical course of patients with congenitally corrected transposition of the great arteries. Am J Cardiol, 1999, 83: 558-562.
9. Warnes CA. Transposition of the great arteries. Circulation, 2006, 114: 26992709.
10. Prieto LR, Hordof AJ, Secic M, et al. Progressive tricuspid valve disease in patients with congenitally corrected transposition of the great arteries. Circulation, 1998, 98: 997-1005.
11. Kral Kollars CA, Gelehrter S, Bove EL, et al. Effects of morphologic left ventricular pressure on right ventricular geometry and tricuspid valve regurgitation in patients with congenitally corrected transposition of the great arteries. Am J Cardiol, 2010, 105: 735-739.
12. Scherptong RW, Vliegen HW, Winter MM, et al. Tricuspid valve surgery in adults with a dysfunctional systemic right ventricle: repair or replace? Circulation, 2009, 119: 1467-1472.
13. Rutledge JM, Nihill MR, Fraser CD, et al. Outcome of 121 patients with congenitally corrected transposition of the great arteries. Pediatr Cardiol, 2002, 23: 137-145.
14. Dodge-Khatami A, Kadner A, Berger MDF, et al. In the footsteps of senning: lessons learned from atrial repair of transposition of the great arteries. Ann Thorac Surg, 2005, 79: 1433-1444.
15. Hraska V, Duncan BW, Mayer JE Jr, et al. Long-term outcome of surgically treated patients with corrected transposition of the great arteries. J Thorac Cardiovasc Surg, 2005, 129: 182-191.
16. Mongeon FP, Connolly HM, Dearani JA, et al. Congenitally corrected transposition of the great arteries ventricular function at the time of systemic atrioventricular valve replacement predicts long-term ventricular function. J Am Coll Cardiol, 2011, 57: 2008-2017.
17. van Son JA, Danielson GK, Huhta JC, et al. Late results of systemic atrioventricular valve replacement in corrected transposition. J Thorac Cardiovasc Surg, 1995, 109: 642-652.
18. Koolbergen DR, Ahmed Y, Bouma BJ, et al. Follow-up after tricuspid valve surgery in adult patients with systemic right ventricles. Eur J Cardiothorac Surg, 2016, 50: 456-463.
19. Acar P, Sidi D, Bonnet D, et al. Maintaining tricuspid valve competence in double discordance: a challenge for the paediatric cardiologist. Heart, 1998, 80: 479-483.
20. Talwar S, Ahmed T, Saxena A, et al. Morphology, surgical techniques, and outcomes in patients above 15 years undergoing surgery for congenitally corrected transposition of great arteries. World J Pediatr Congenit Heart Surg, 2013, 4: 271-277.
21. Benson LN, Burns R, Schwaiger M, et al. Radionuclide angiographic evaluation of ventricular function in isolated congenitally corrected transposition of the great arteries. Am J Cardiol, 1986, 58: 319-324.
22. Lim HG, Lee JR, Kim YJ, et al. Outcomes of biventricular repair for congenitally corrected transposition of the great arteries. Ann Thorac Surg, 2010, 89: 159-167.
23. Devaney EJ, Charpie JR, Ohye RG, et al. Combined arterial switch and senning operation for congenitally corrected transposition of the great arteries: patient selection and intermediate results. J Thorac Cardiovasc Surg, 2003, 125: 500-507.
24. Poirier NC, Yu JH, Brizard CP, et al. Long-term results of left ventricular reconditioning and anatomic correction for systemic right ventricular dysfunction after atrial switch procedures. J Thorac Cardiovasc Surg, 2004, 127: 975-981.
25. Bove EL, Ohye RG, Devaney EJ, et al. Anatomic correction of congenitally corrected transposition and its close cousins. Cardiol Young, 2006, 16(Suppl 3): 85-90.
26. Duncan BW, Mee RB. Management of the failing systemic right ventricle. Semin Thorac Cardiovasc Surg, 2005, 17: 160-169.
27. Mee RB. Severe right ventricular failure after mustard or senning operation. Two-stage repair: pulmonary artery banding and switch. J Thorac Cardiovasc Surg, 1986, 92: 385-390.
28. Winlaw DS, McGuirk SP, Balmer C, et al. Intention-to-treat analysis of pulmonary artery banding in conditions with a morphological right ventricle in the systemic circulation with a view to anatomic biventricular repair. Circulation, 2005, 111: 405-411.
29. Wilkinson JL, Smith A, Lincoln C, et al. Conducting tissues in congenitally corrected transposition with situs inversus. Br Heart J, 1978, 40: 41-48.
30. Anderson RH, Becker AE, Arnold R, et al. The conducting tissues in congenitally corrected transposition. Circulation, 1974, 50: 911-923.
31. Pettersen E, Helle-Valle T, Edvardsen T, et al. Contraction pattern of log-rank the systemic right ventricle shift from longitudinal to circumferential shortening and absent global ventricular torsion. J Am Coll Cardiol, 2007, 49: 2450-2456.
32. Hornung TS, Bernard EJ, Celermajer DS, et al. Right ventricular dysfunction in congenitally corrected transposition of the great arteries. Am J Cardiol, 1999, 84: 1116-1119, A1110.
33. Hauser M, Bengel FM, Hager A, et al. Impaired myocardial blood flow and coronary flow reserve of the anatomical right systemic congenitally corrected transposition of ventricle the great in patients with arteries. Heart, 2003, 89: 1231-1235.
34. Hauser M, Meierhofer C, Schwaiger M, et al. Myocardial blood flow in patients with transposition of the great arteries—risk factor for dysfunction of the morphologic systemic right ventricle late after atrial repair. Circ J, 2015, 79: 425-431.
35. Hornung TS, Bernard EJ, Jaeggi ET, et al. Myocardial perfusion defects and associated systemic ventricular dysfunction in congenitally corrected transposition of the great arteries. Heart, 1998, 80: 322-326.
36. Huhta JC, Maloney JD, Ritter DG, et al. Complete atrioventricular block in patients with atrioventricular discordance. Circulation, 1983, 67: 1374-1377.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Long-term outcome and risk factor analysis of tricuspid valve replacement for adult patients with congenitally corrected transposition of great arteries

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