TY - JOUR
T1 - Tricuspid valve surgery in transposition of the great arteries with a systemic right ventricle
AU - Amir, Rawan
AU - Ladouceur, Magalie
AU - Danford, David
AU - Aboulhosn, Jamil
AU - Antonova, Petra
AU - Baker, David
AU - Bouchardy, Judith
AU - Budts, Werner
AU - Burchill, Luke J.
AU - Celermajer, David S.
AU - Cotts, Timothy
AU - Cramer, Jonathan
AU - Dehghani, Payam
AU - Fusco, Flavia
AU - Dellborg, Mikael
AU - DeZorzi, Christopher
AU - Gallego, Pastora
AU - Gatzoulis, Michael
AU - Ginde, Salil
AU - Grewal, Jasmine
AU - Gupta, Tripti
AU - Han, Frank
AU - Jameson, Susan M.
AU - del Cerro Marin, Maria Jesus
AU - John, Anitha S.
AU - Kauling, Robert M.
AU - Kay, W. Aaron
AU - Kay, Joseph
AU - Khairy, Paul
AU - Krieger, Eric V.
AU - Kuo, Marissa
AU - Labombarda, Fabien
AU - Lubert, Adam M.
AU - Magalski, Anthony
AU - Nicolarsen, Jeremy
AU - O'Donnell, Clare
AU - Opotowsky, Alexander R.
AU - Pavsic, Nejc
AU - Prokselj, Katja
AU - Pylypchuk, Stephen
AU - Rodriguez, Fred
AU - Rodriguez-Monserrate, Carla P.
AU - Roos-Hesselink, Jolien
AU - Rutz, Tobias
AU - Fuente, Maria Alvarez
AU - Sarubbi, Berardo
AU - Shah, Sangeeta
AU - van de Bruaene, Alexander
AU - van Dissel, Alexandra
AU - Garrido-Lestache, Maria Elvira
AU - Muhll, Isabelle Vonder
AU - Wilson, William M.
AU - Wong, Tom
AU - Wong, Joshua
AU - Yeung, Elizabeth
AU - Kutty, Shelby
AU - on behalf of the AARCC and MARES research groups
AU - Broberg, Craig S.
AU - Cedars, Ari
N1 - Publisher Copyright:
© 2025 Elsevier B.V.
PY - 2026/2/15
Y1 - 2026/2/15
N2 - Background: Adults with transposition of the great arteries (TGA) and systemic morphologic right ventricle (SRV) have a high prevalence of SRV failure with accompanying tricuspid valve regurgitation (TR). It is unknown if tricuspid valve surgery (TVS) impacts clinical outcomes in this setting. Methods: Data were gathered from an international cohort of patients with TGA and SRV. From this group, patients who had previously undergone tricuspid valve surgery (TVS) were propensity matched with patients who had not undergone surgery and followed for 10.5 ± 4.6 years. The impact of surgery on the probability of the combined endpoint of death/transplant/MCS was investigated. Variables associated with favorable outcomes were explored. Results: Among 2562 patients with TGA and SRV, 140 patients with prior TVS were propensity matched to 140 controls without previous TVS. In the TVS group, primary end point was noted in 20 cases with 15 deaths (10.7 %), 3 transplant listings (2.1 %) and 5 MCS implants (3.6 %). Among controls, primary end point occurred in 23 patients (16.4 %) with 15 deaths (10.7 %), 7 transplant listings (5.0 %) and 2 MCS implants (1.4 %). There was no difference between groups in event free survival. Lower rates of combined endpoint were observed in TVS group with moderate-severe TR and mild-moderate SRV dysfunction. Sensitivity analyses to address potential immortal-time bias were performed in the subset who underwent surgery during the observation period and produced similar results. Among patients with severe SRV dysfunction there was no difference in primary outcome between groups. Similarly, no difference in outcomes was observed between congenitally corrected (ccTGA) and atrial corrected transposition of the great arteries (acTGA) patients. Conclusions: For acTGA and ccTGA patients with SRV and moderate-severe TR, surgical intervention prior to development of severe RV dysfunction is recommended. More data are required to determine those with severe SRV dysfunction who may benefit most.
AB - Background: Adults with transposition of the great arteries (TGA) and systemic morphologic right ventricle (SRV) have a high prevalence of SRV failure with accompanying tricuspid valve regurgitation (TR). It is unknown if tricuspid valve surgery (TVS) impacts clinical outcomes in this setting. Methods: Data were gathered from an international cohort of patients with TGA and SRV. From this group, patients who had previously undergone tricuspid valve surgery (TVS) were propensity matched with patients who had not undergone surgery and followed for 10.5 ± 4.6 years. The impact of surgery on the probability of the combined endpoint of death/transplant/MCS was investigated. Variables associated with favorable outcomes were explored. Results: Among 2562 patients with TGA and SRV, 140 patients with prior TVS were propensity matched to 140 controls without previous TVS. In the TVS group, primary end point was noted in 20 cases with 15 deaths (10.7 %), 3 transplant listings (2.1 %) and 5 MCS implants (3.6 %). Among controls, primary end point occurred in 23 patients (16.4 %) with 15 deaths (10.7 %), 7 transplant listings (5.0 %) and 2 MCS implants (1.4 %). There was no difference between groups in event free survival. Lower rates of combined endpoint were observed in TVS group with moderate-severe TR and mild-moderate SRV dysfunction. Sensitivity analyses to address potential immortal-time bias were performed in the subset who underwent surgery during the observation period and produced similar results. Among patients with severe SRV dysfunction there was no difference in primary outcome between groups. Similarly, no difference in outcomes was observed between congenitally corrected (ccTGA) and atrial corrected transposition of the great arteries (acTGA) patients. Conclusions: For acTGA and ccTGA patients with SRV and moderate-severe TR, surgical intervention prior to development of severe RV dysfunction is recommended. More data are required to determine those with severe SRV dysfunction who may benefit most.
KW - Atrial corrected transposition of the great arteries
KW - Congenitally corrected transposition of the great arteries
KW - Systemic right ventricle
KW - Tricuspid regurgitation
KW - Tricuspid valve surgery
UR - https://www.scopus.com/pages/publications/105023514875
U2 - 10.1016/j.ijcard.2025.134055
DO - 10.1016/j.ijcard.2025.134055
M3 - Article
C2 - 41309003
SN - 0167-5273
VL - 445
JO - International journal of cardiology
JF - International journal of cardiology
M1 - 134055
ER -