Infographic: Tricuspid valve surgery in transposition of the great arteries with a systemic right ventricle

Infographic · May 2026 · 2 min read

In brief

International cohort study of 2,562 TGA patients found tricuspid valve surgery showed benefit in those with moderate-severe regurgitation and mild-moderate ventricular dysfunction, but no advantage in severe dysfunction. Propensity-matched analysis over 10+ years revealed similar mortality/transplant rates overall between surgical and non-surgical groups.

Tricuspid valve surgery shows no overall survival benefit in TGA patients with systemic right ventricles when compared to matched controls.
Surgery before severe RV dysfunction develops may improve outcomes in patients with moderate-severe TR and mild-moderate RV dysfunction.
Once severe RV dysfunction is present, tricuspid valve surgery does not appear to alter clinical outcomes including death, transplant, or MCS.
Both atrial-corrected and congenitally-corrected TGA patients show similar outcomes, suggesting surgical timing matters more than TGA subtype.
Early intervention is key: waiting until severe ventricular dysfunction develops may miss the therapeutic window for tricuspid valve surgery.

Written by the GCMD Library team from the infographic.

The infographic uses a teal, purple, and yellow color scheme with a globe icon, heart diagram, and surgical team illustration. Information is organized in distinct colored blocks flowing from top to bottom, with key statistics highlighted in large text and bullet points for outcomes and conclusions.

Rawan Amir, Magalie Ladouceur, David Danford, Jamil Aboulhosn, Petra Antonova, David Baker, Judith Bouchardy, Werner Budts, Luke J Burchill, David S Celermajer, Timothy Cotts, Jonathan Cramer, Payam Dehghani, Flavia Fusco, Mikael Dellborg, Christopher DeZorzi, Pastora Gallego, Michael Gatzoulis, Salil Ginde, Jasmine Grewal, Tripti Gupta, Frank Han, Susan M Jameson, Maria Jesus Del Cerro Marin, Anitha S John, Robert M Kauling, W Aaron Kay, Joseph Kay, Paul Khairy, Eric V Krieger, Marissa Kuo, Fabien Labombarda, Adam M Lubert, Anthony Magalski, Jeremy Nicolarsen, Clare O'Donnell, Alexander R Opotowsky, Nejc Pavsic, Katja Prokselj, Stephen Pylypchuk, Fred Rodriguez 3rd, Carla P Rodriguez-Monserrate, Jolien Roos-Hesselink, Tobias Rutz, Maria Alvarez Fuente, Berardo Sarubbi, Sangeeta Shah, Alexander Van De Bruaene, Alexandra van Dissel, Maria Elvira Garrido-Lestache, Isabelle Vonder Muhll, William M Wilson, Tom Wong, Joshua Wong, Elizabeth Yeung, Shelby Kutty, Craig S Broberg, Ari Cedars

Background: Adults with transposition of the great arteries (TGA) and systemic morphologic right ventricle (SRV) have a high prevalence of SRV failure with accompanying tricuspid valve regurgitation (TR). It is unknown if tricuspid valve surgery (TVS) impacts clinical outcomes in this setting.

Methods: Data were gathered from an international cohort of patients with TGA and SRV. From this group, patients who had previously undergone tricuspid valve surgery (TVS) were propensity matched with patients who had not undergone surgery and followed for 10.5 ± 4.6 years. The impact of surgery on the probability of the combined endpoint of death/transplant/MCS was investigated. Variables associated with favorable outcomes were explored.

Results: Among 2562 patients with TGA and SRV, 140 patients with prior TVS were propensity matched to 140 controls without previous TVS. In the TVS group, primary end point was noted in 20 cases with 15 deaths (10.7 %), 3 transplant listings (2.1 %) and 5 MCS implants (3.6 %). Among controls, primary end point occurred in 23 patients (16.4 %) with 15 deaths (10.7 %), 7 transplant listings (5.0 %) and 2 MCS implants (1.4 %). There was no difference between groups in event free survival. Lower rates of combined endpoint were observed in TVS group with moderate-severe TR and mild-moderate SRV dysfunction. Sensitivity analyses to address potential immortal-time bias were performed in the subset who underwent surgery during the observation period and produced similar results. Among patients with severe SRV dysfunction there was no difference in primary outcome between groups. Similarly, no difference in outcomes was observed between congenitally corrected (ccTGA) and atrial corrected transposition of the great arteries (acTGA) patients.

Conclusions: For acTGA and ccTGA patients with SRV and moderate-severe TR, surgical intervention prior to development of severe RV dysfunction is recommended. More data are required to determine those with severe SRV dysfunction who may benefit most.

The text in the image

Tricuspid valve surgery in transposition of the great arteries (TGA) with a systemic right ventricle | International multicenter cohort study | 2015-2019 | 2,562 patients w/ TGA and systemic right ventricle | 140 surgical patients matched with 140 non-surgical controls | Median follow-up: 10.5 ± 4.6 years | Outcomes measured: mortality, heart transplant, and mechanical circulatory support | In TGA, systemic right ventricular dysfunction and tricuspid regurgitation frequently develop and drive progression to heart failure | Better outcomes in patients with: moderate-severe tricuspid regurgitation | mild-moderate systemic RV dysfunction | Tricuspid valve surgery did not improve outcomes for all patients | No benefit once RV dysfunction became severe | Conclusion: Earlier tricuspid valve surgery may improve outcomes in TGA patients with significant valve leakage—before severe right ventricular dysfunction develops. | https://pubmed.ncbi.nlm.nih.gov/41309003/ | Amir R et al. | Johns Hopkins Hospital | Baltimore, MD, USA | @LizzyPAC8 | @globalcastmd | @StayCurrentMD | Cincinnati Children's