Mid-term outcomes of tricuspid valve detachment versus non-detachment for ventricular septal defect closure_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HE Zedong , WU Zhuheng ,  DIAN Ke

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

DIAN Ke, Email: pangzai356249@126.com

Keywords：

Ventricular septal defect; tricuspid valve detachment; tricuspid valve regurgitation; residual shunting

DOI：

10.7507/1007-4848.202303015

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Objective To evaluate the mid-term outcomes between tricuspid valve detachment (TVD) and non-detachment (NTVD) for ventricular septal defect (VSD).Methods The patients who underwent perimembranous VSD repair in the Department of Cardiovascular Surgery, West China Hospital from 2015 to 2020 were included. According to the surgical method, the patients were divided into a TVD group and a NTVD group. The clinical data of the two groups were compared.Results Totally 538 patients were included in the study. There were 240 patients in the TVD group, including 121 males and 119 females, with an average age of 3.85±8.42 years and an average weight of 14.12±12.97 kg. There were 298 patients in the NTVD group, including 149 males and 149 females, with an average age of 4.42±9.36 years and an average weight of 14.87±12.51 kg. There was no statistical difference in the age, weight, sex, preoperative New York Heart Association (NYHA) classification or tricuspid regurgitation (TR) degree between the two groups (P＞0.05). Median follow-up was 30 (23, 40) months in the TVD group, and 29 (23, 41) months in the NTVD group (P=0.600). After operation, one patient in each group developed third-degree atrioventricular block and recovered to sinus rhythm before discharge (P=0.848). No pacemaker was needed. There was no statistical difference in the length of stay (P=0.054), mortality (P=1.000), in-hospital reoperation (P=0.199), or follow-up reoperation (P=0.505). More than 98% of patients in both groups had postoperative TR less than moderate (P=0.926). At the last follow-up, only 7 (2.9%) patients in the TVD group were detected trivial residual shunting, and 14 (4.7%) in the NTVD group (P=0.289). No one needed to have reoperation because of residual VSD. The TVD group showed less TR during the follow-up (P=0.019).Conclusion TVD is an alternative technique which can be safely used in the closure of VSD, especially in technologically mature medical center. Appropriate tricuspid valve detachment for those hard-to-expose VSDs does not result in poorer tricuspid valve function or higher risk of atrioventricular block, and might reduce the incidence of residual shunting.

Citation： HE Zedong, WU Zhuheng, DIAN Ke. Mid-term outcomes of tricuspid valve detachment versus non-detachment for ventricular septal defect closure. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(8): 1137-1142. doi: 10.7507/1007-4848.202303015 Copy

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2.	Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56, 109 births. Incidence and natural history. Circulation, 1971, 43(3): 323-332.
3.	Penny DJ, Vick GW. Ventricular septal defect. Lancet, 2011, 377(9771): 1103-1112.
4.	Gabriel HM, Heger M, Innerhofer P, et al. Long-term outcome of patients with ventricular septal defect considered not to require surgical closure during childhood. J Am Coll Cardiol, 2002, 39(6): 1066-1071.
5.	Hudspeth AS, Cordell AR, Meredith JH, et al. An improved transatrial approach to the closure of ventricular septal defects. J Thorac Cardiovasc Surg, 1962, 43: 157-165.
6.	Kapoor L, Gan MD, Bandyhopadhyay A, et al. Improved exposure of isolated perimembranous ventricular septal defects. Ann Thorac Surg, 2000, 69(1): 291-292.
7.	Pourmoghadam KK, Boron A, Ruzmetov M, et al. Septal leaflet versus chordal detachment in closure of hard-to-expose ventricular septal defects. Ann Thorac Surg, 2018, 106(3): 814-821.
8.	Ling Y, Bian X, Wang Y, et al. Does tricuspid valve detachment improve outcomes compared with the non-tricuspid valve detachment approach in ventricular septal defect closure? Interact Cardiovasc Thorac Surg, 2021, 32(3): 483-488.
9.	Sasson L, Katz MG, Ezri T, et al. Indications for tricuspid valve detachment in closure of ventricular septal defect in children. Ann Thorac Surg, 2006, 82(3): 958-963.
10.	Bol-Raap G, Weerheim J, Kappetein AP, et al. Follow-up after surgical closure of congenital ventricular septal defect. Eur J Cardiothorac Surg, 2003, 24(4): 511-515.
11.	Weymann A, Georgiev S, Vogelsang C, et al. Temporary tricuspid valve detachment for ventricular septal defect closure: Is it worth doing it? Heart Surg Forum, 2013, 16(2): E99-E102.
12.	Zhao J, Li J, Wei X, et al. Tricuspid valve detachment in closure of congenital ventricular septal defect. Tex Heart Inst J, 2003, 30(1): 38-41.
13.	Bang JH, Park CS, Park JJ, et al. Detachment of the tricuspid valve for ventricular septal defect closure in infants younger than 3 months. J Thorac Cardiovasc Surg, 2016, 152(2): 491-496.
14.	Lee JH, Cho S, Kwak JG, et al. Tricuspid valve detachment for ventricular septal defect closure in infants <5 kg: Should we be hesitant? Eur J Cardiothorac Surg, 2021, 60(3): 544-551.
15.	Siehr SL, Hanley FL, Reddy VM, et al. Incidence and risk factors of complete atrioventricular block after operative ventricular septal defect repair. Congenit Heart Dis, 2014, 9(3): 211-215.
16.	Bilen ?, Akkaya G, Tuncer ON, et al. Assessment of tricuspid valve detachment efficiency for ventricular septal defect closure: A retrospective comparative study. Acta Cardiol Sin, 2020, 36(4): 360-366.
17.	Fraser CD, Zhou X, Palepu S, et al. Tricuspid valve detachment in ventricular septal defect closure does not impact valve function. Ann Thorac Surg, 2018, 106(1): 145-150.

1. Minette MS, Sahn DJ. Ventricular septal defects. Circulation, 2006, 114(20): 2190-2197.
2. Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56, 109 births. Incidence and natural history. Circulation, 1971, 43(3): 323-332.
3. Penny DJ, Vick GW. Ventricular septal defect. Lancet, 2011, 377(9771): 1103-1112.
4. Gabriel HM, Heger M, Innerhofer P, et al. Long-term outcome of patients with ventricular septal defect considered not to require surgical closure during childhood. J Am Coll Cardiol, 2002, 39(6): 1066-1071.
5. Hudspeth AS, Cordell AR, Meredith JH, et al. An improved transatrial approach to the closure of ventricular septal defects. J Thorac Cardiovasc Surg, 1962, 43: 157-165.
6. Kapoor L, Gan MD, Bandyhopadhyay A, et al. Improved exposure of isolated perimembranous ventricular septal defects. Ann Thorac Surg, 2000, 69(1): 291-292.
7. Pourmoghadam KK, Boron A, Ruzmetov M, et al. Septal leaflet versus chordal detachment in closure of hard-to-expose ventricular septal defects. Ann Thorac Surg, 2018, 106(3): 814-821.
8. Ling Y, Bian X, Wang Y, et al. Does tricuspid valve detachment improve outcomes compared with the non-tricuspid valve detachment approach in ventricular septal defect closure? Interact Cardiovasc Thorac Surg, 2021, 32(3): 483-488.
9. Sasson L, Katz MG, Ezri T, et al. Indications for tricuspid valve detachment in closure of ventricular septal defect in children. Ann Thorac Surg, 2006, 82(3): 958-963.
10. Bol-Raap G, Weerheim J, Kappetein AP, et al. Follow-up after surgical closure of congenital ventricular septal defect. Eur J Cardiothorac Surg, 2003, 24(4): 511-515.
11. Weymann A, Georgiev S, Vogelsang C, et al. Temporary tricuspid valve detachment for ventricular septal defect closure: Is it worth doing it? Heart Surg Forum, 2013, 16(2): E99-E102.
12. Zhao J, Li J, Wei X, et al. Tricuspid valve detachment in closure of congenital ventricular septal defect. Tex Heart Inst J, 2003, 30(1): 38-41.
13. Bang JH, Park CS, Park JJ, et al. Detachment of the tricuspid valve for ventricular septal defect closure in infants younger than 3 months. J Thorac Cardiovasc Surg, 2016, 152(2): 491-496.
14. Lee JH, Cho S, Kwak JG, et al. Tricuspid valve detachment for ventricular septal defect closure in infants <5 kg: Should we be hesitant? Eur J Cardiothorac Surg, 2021, 60(3): 544-551.
15. Siehr SL, Hanley FL, Reddy VM, et al. Incidence and risk factors of complete atrioventricular block after operative ventricular septal defect repair. Congenit Heart Dis, 2014, 9(3): 211-215.
16. Bilen ?, Akkaya G, Tuncer ON, et al. Assessment of tricuspid valve detachment efficiency for ventricular septal defect closure: A retrospective comparative study. Acta Cardiol Sin, 2020, 36(4): 360-366.
17. Fraser CD, Zhou X, Palepu S, et al. Tricuspid valve detachment in ventricular septal defect closure does not impact valve function. Ann Thorac Surg, 2018, 106(1): 145-150.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Mid-term outcomes of tricuspid valve detachment versus non-detachment for ventricular septal defect closure

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