# The long-term impact of the tricuspid valve intervention after Fontan completion

## TL;DR

This study examines how tricuspid valve interventions affect long-term outcomes in patients with a single right ventricle after Fontan surgery.

## Contribution

The study identifies specific risk factors and outcomes associated with repeat tricuspid valve interventions after Fontan completion.

## Key findings

- Repeat tricuspid valve intervention is linked to significantly lower long-term survival rates.
- Younger age at Fontan surgery and ventricular dysfunction are significant risk factors for poor outcomes.
- Successful tricuspid valve intervention can result in survival outcomes comparable to non-intervention patients.

## Abstract

The incompetence of the tricuspid valve (TV) may predispose to unfavorable results of Fontan palliation in patients with single right ventricle (RV). This study aims to reveal the effect of TV intervention in patients with single RV on long-term outcomes after Fontan completion.

A single-center retrospective cohort study was conducted with patients who underwent Fontan completion from 1985 to 2017. There was a total of 678 patients with single RV. A total of 128 patients (18.8%) underwent TV intervention at any stage (TVI group); 30 of them (23.4%) underwent repeat TV surgery (repeat TVI subgroup). The control group comprises 550 patients (81.2%) who had no TV surgery regardless of the degree of TR (non TVI group).

The median follow-up was 8.8 (± 7.6) years. Overall transplant- and Fontan takedown-free survival was 62.5% (95% CI 59.2%-64.9%) at 20 years. The repeat TVI group had significantly lower transplant and takedown-free survival rates (Non TVI 76.5% vs. Single TVI 75.3% vs. repeat TVI 56.0% at 15 years, P = 0.02). The younger age at Fontan (1.12 [95% CI 1.02–1.22], p = 0.019), repeat TVI (3.33 [95% CI 1.57–7.04], p = 0.002), TV intervention after Fontan (6.14 [95% CI 2.60–14.50], p < 0.001), significant ventricular dysfunction before Fontan (3.12 [95% CI 1.12–8.30], p = 0.028) and any concomitant procedure at Fontan (1.98 [95% CI 1.16–3.37], p = 0.013) were the significant risk factors for transplant and takedown free- survival.

Repeat TV intervention during the Fontan was associated with inferior outcomesin patients with morphologic systemic RV. Successful TV intervention could provide comparable long-term survival outcomes to non-TV intervention patients.