Surgical Management of Transvenous Lead-induced Tricuspid Regurgitation in Adult and Pediatric Patients with Congenital Heart Disease

ABSTRACT Objective To evaluate outcomes of surgical management of lead-induced tricuspid regurgitation (TR) in patients with congenital heart disease (CHD). Methods We analyzed 54 consecutive patients who underwent tricuspid valve (TV) surgery from 1998 to 2015 for lead-induced TR. Primary endpoints, including mortality, TV re-interventions, and longitudinal TR measurements, were analyzed with the Kaplan-Meier methods or with repeated measures proportional odds modeling. Results Median age was 48.2 years (interquartile range, 37.3-59.0 years); 31 (57.4%) were females; two (3.7%) were children. Thirty patients (55.6%) underwent TV repair and 24 (44.4%) had replacement, and 52 underwent concomitant cardiac procedures. Thirty-day mortality was 1.9% (repair: 3.3%, replacement: 0.0%). Five-year survival was 80.4% overall and 79.7% and 81.4% for the repair and replacement groups, respectively. In response to surgery, TR improved in both groups (each P Conclusions Despite the need for concomitant cardiac procedures in the vast majority of the patients, early mortality was low following TV surgery. Survival and rate of TV re-intervention were comparable between repair and replacement groups. However, TV repair is associated with progressive TR during intermediate follow-up, especially in patients with severe TR preoperatively.