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Tricuspid Regurgitation and Impact of Surgical Valve Intervention in the Single Ventricle Reconstruction Trial

J F Cnota1, S M Chowdhury2, A Floh3

  • 1Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA. James.cnota@cchmc.org.

Pediatric Cardiology
|February 18, 2026
PubMed

Insights

Tricuspid regurgitation (TR) in single right ventricle (RV) anomalies worsens outcomes. Early TR, especially post-Norwood and pre-stage II, is linked to lower transplant-free survival, and tricuspid valve intervention during early stages does not improve survival.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease
  • Echocardiography

Background:

  • Tricuspid regurgitation (TR) is a common complication in single right ventricle (RV) anomalies.
  • TR significantly impacts patient outcomes during staged surgical palliation for single RV.
  • Understanding TR progression and its effect on survival is crucial for managing these complex cases.

Purpose of the Study:

  • To compare serial echocardiographic measures of TR throughout staged palliation in single RV patients.
  • To determine the impact of TR severity and tricuspid valve (TV) intervention on transplant-free survival.
  • To analyze the relationship between TR, RV size/function, and outcomes in the Pediatric Heart Network (PHN) cohort.

Main Methods:

  • Serial echocardiograms were analyzed from 543 participants in the PHN Single Ventricle Reconstruction trial at six time points.
  • TR was categorized as mild or greater than mild (> mild).
  • Statistical analyses included McNemar's test, t-tests, and survival analysis to assess TR progression and its impact on transplant-free survival.

Main Results:

  • The prevalence of > mild TR increased from 12% at baseline to 24% post-Norwood (p < 0.001), stabilizing thereafter.
  • > mild TR was associated with increased TV annular area and RV volume, but not decreased RV function.
  • Transplant-free survival at 6 years was lower in patients with > mild TR at any time point except pre-Fontan.

Conclusions:

  • Severe tricuspid regurgitation (> mild) early in staged palliation (baseline, post-Norwood, pre-stage II) is associated with decreased transplant-free survival.
  • Tricuspid valve intervention during the Norwood or Stage II procedures was not associated with improved survival outcomes.
  • These findings highlight the prognostic significance of early TR in single RV patients and question the timing of TV interventions.

Keywords:
Hypoplastic left heart syndromeNorwood procedureSurvivalTricuspid regurgitation

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