# Early Tricuspid Valve Surgery for Heart Failure in Congenital Heart Disease — GCMD Library

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; AARCC and MARES research groups

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.

Type: video · 0 min · posted 2026-05-15
Canonical: https://library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050

## Chapters
- [0:00](https://library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050?t=0) Timing of Tricuspid Valve Surgery in TGA

## Statements
- "In adults with transposition of the great arteries, the right ventricle sometimes has to pump blood to the whole body." — Lizzie Lee (clinical) [0:08](https://library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050?t=8)
- "The right ventricle was not built to pump blood to the whole body." — Lizzie Lee (clinical) [0:08](https://library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050?t=8)
- "Over time, many patients with transposition of the great arteries develop severe tricuspid regurgitation and worsening heart function." — Lizzie Lee (clinical) [0:16](https://library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050?t=16)
- "Patients with moderate to severe tricuspid valve leakage but only mild to moderate ventricular dysfunction had better outcomes after surgery." — Lizzie Lee (clinical) [0:25](https://library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050?t=25)
- "If the right ventricle was already severely weak, tricuspid valve surgery did not make a difference in outcomes." — Lizzie Lee (clinical) [0:33](https://library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050?t=33)
- "In patients with transposition of the great arteries, earlier tricuspid valve surgery can improve outcomes." — Lizzie Lee (clinical) [0:37](https://library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050?t=37)

## Transcript
What if fixing a heart valve earlier could prevent heart failure and congenital heart disease? I'm Lizzie Lee from Cincinnati Children's, and this is an article you should know about. In adults with transposition of the great arteries, the right ventricle sometimes has to pump blood to the whole body, a job that it wasn't built for. Over time, many patients develop severe tricuspid regurgitation and worsening heart function. This study looked at whether tricuspid valve surgery helps prevent that. The key finding, patients with moderate to severe valve leakage, but only mild to moderate ventricular dysfunction had better outcomes after surgery. But if the right ventricle was already severely weak, surgery didn't make a difference. Bottom line, in patients with transposition of the great arteries, earlier valve surgery can improve their outcomes. Let us know what you think and stay tuned for more articles that you should know about.

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Not medical advice · citation policy: https://library.globalcastmd.com/ai