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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

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Long-term tricuspid valve function after Norwood operation.

Maryam Elmi¹, Edward J Hickey, William G Williams

¹Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.

The Journal of Thoracic and Cardiovascular Surgery

|June 28, 2011

Summary

This summary is machine-generated.

Up to 25% of survivors of Norwood palliation for hypoplastic left heart syndrome require tricuspid valve surgery. Mitral atresia and longer ischemic times during Norwood surgery are key risk factors for intervention.

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Chronic Ovine Model of Right Ventricular Failure and Functional Tricuspid Regurgitation

Chronic Ovine Model of Right Ventricular Failure and Functional Tricuspid Regurgitation

Published on: March 17, 2023

Area of Science:

Pediatric Cardiology
Congenital Heart Surgery
Echocardiography

Background:

Long-term outcomes after Norwood palliation depend on systemic tricuspid valve function.
Tricuspid valve performance is critical for patients with a systemic right ventricle.

Purpose of the Study:

To identify factors associated with tricuspid valve intervention after Norwood stage 1 palliation.
To evaluate the impact of tricuspid valve intervention on survival and right ventricular function.

Main Methods:

Retrospective analysis of 219 children undergoing Norwood stage 1 palliation (1990-2007).
Competing risks analysis for tricuspid valve intervention and death.
Time-related outcome analysis of 2705 echocardiogram reports using repeated measures adjustment.
Bootstrapping for variable selection.

Main Results:

Approximately 25% of survivors required tricuspid valve intervention (27 repairs, 3 replacements).
Risk factors included mitral atresia, longer myocardial ischemic time during Norwood, and moderate/severe tricuspid regurgitation post-Norwood.
Tricuspid valve intervention did not compromise survival or worsen right ventricular function.
A late hazard for intervention emerged 10-15 years post-Norwood.

Conclusions:

Tricuspid valve surgery is common and necessary in up to 25% of survivors of single ventricle palliation.
Mitral atresia and prolonged myocardial ischemia during Norwood are significant risks.
While tricuspid repair preserves RV function, the late risk of intervention warrants further investigation for long-term implications.