Outcomes of Tricuspid Valve Repair With Artificial Neochordae in Pediatric and Adult Patients.

Abstract

There are sparse data on outcomes after expanded polytetrafluoroethylene artificial neochordae (ePTFE-AN) for tricuspid valve (TV) repair. We evaluated outcomes after TV repair with ePTFE-AN in both pediatric and adult patients. We analyzed clinical data of 87 consecutive patients who underwent ePTFE-AN implantation at the time of TV repair from 1998 to 2020. Patients were categorized into pediatric and adult groups. There were 29 pediatric (33.3%) and 58 adult (66.7%) patients. The most common etiology of tricuspid regurgitation (TR) was congenital (pediatrics: 86.2% [25 of 29]; adults: 39.7% [23 of 59]). The median number of pairs of ePTFE-AN implanted was 2 (interquartile range [IQR], 2-5 pairs) for pediatric and 3 (IQR, 2-4 pairs) for adult patients. There was no early death. Three adult patients (5.2%) required early TV reoperation, and 4 patients (1 pediatric, 3 adults) underwent late TV reintervention. Etiology of TR was congenital in 4 of the 6 adults who required TV reintervention. The 3-year cumulative risk of TV reintervention was 0.0% for pediatric and 7.3% (95% CI, 0.4%-14.2%) for adult patients. There was significant improvement in TR grade after TV repair at dismissal and at the latest echocardiographic follow-up in each group (P < .001). Severe TR developed in 1 pediatric patient and 7 adult patients during follow-up, and 6 (1 pediatric, 5 adults) of them underwent TV reoperation. ePTFE-AN implantation in the TV position can be performed safely and effectively with no early death. In adult patients with congenital TR, patient selection is critical to achieve a durable outcome after TV repair.