Management of Severe Pulmonary Regurgitation and Severe Secondary Tricuspid Regurgitation

Background: Management of severe functional tricuspid regurgitation (TR) at the time of pulmonary valve replacement in the setting of severe pulmonary regurgitation in adult congenital heart diseases has not been examined clearly. Methods: Thirty-five patients with severe functional TR who were candidates for pulmonary valve replacement with congenital heart diseases were chosen. Baseline features and echocardiographic and clinical findings were compared between isolated pulmonary valve replacement, tricuspid valve repair, and pulmonary valve replacement groups. Results: In the tricuspid valve repair group, TR was significantly improved compared with the isolated pulmonary valve replacement group in the early postoperative (P<0.001), short-term (P=0.009), and mid-term (P=0.035) follow-up periods. Functional capacity was improved in the tricuspid valve repair group (P=0.009) compared with the isolated pulmonary valve replacement group. Conclusions: Our study has introduced the concomitant tricuspid valve repair as a safe approach in patients with severe functional TR at the time of pulmonary valve replacement. It can efficiently reduce TR severity in mid-term follow-up and improve the long-term functional capacity. However, there were no significant effects on mortality during the follow-up period.