Role of tricuspid valve repair in pulmonary atresia with intact ventricular septum: fresh autologous pericardium as a viable option.

OBJECTIVES

This study aimed to evaluate the surgical outcomes of tricuspid valve (TV) leaflet augmentation using fresh autologous pericardium (FAP) in patients with pulmonary atresia with intact ventricular septum (PA-IVS).

METHODS

Nine patients with PA-IVS underwent TV leaflet augmentation (TVLA) using FAP between January 2017 and April 2024. Native TV failure was defined as significant (≥moderate) tricuspid regurgitation and/or stenosis (mean pressure gradient >5 mmHg). Clinical outcomes, including both TV and right ventricle (RV) size and functions, were evaluated using echocardiography and magnetic resonance imaging.

RESULTS

The median age and body weight at the time of surgery were 5.4 years and 21.2 kg, respectively. No operative mortality occurred. During the follow-up period, no late mortalities, reoperations or significant TV leaflet-related complications were observed; native TV failure was not observed in any patients, except one with significant tricuspid regurgitation. Biventricular repair was performed in all patients except one who had undergone preoperative one-and-a-half ventricle repair. After TVLA using FAP, the median TV annulus z-score remained within the normal ranges (preoperative -0.42 [-0.62 to 0.57] versus postoperative -0.51 [-0.95 to -0.13], mean difference: 0.231, 95% confidence interval: -0.338 to 0.800, P = 0.377) and tricuspid regurgitation improved significantly (mean difference: 2.111, 95% confidence interval: 1.510-2.712, P = 0.040). Postoperative magnetic resonance imaging showed that RV function, and cardiac output were preserved within acceptable ranges.

CONCLUSIONS

TVLA using FAP could be a considerable and viable approach to optimize RV growth while preserving RV and TV functions in the long-term in young patients with PA-IVS.