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J Thorac Cardiovasc Surg 2004;127:1682-1687
© 2004 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Tricuspid valve replacement with a mitral homograft in children with rheumatic tricuspid valvulopathy

^a Clinic for Cardiovascular Surgery, University Hospital of Geneva, Geneva, Switzerland
^b Unit for Pediatric Cardiology, University Hospital of Geneva, Geneva, Switzerland,
^c Clinic for Cardiology, University Hospital of Geneva, Geneva, Switzerland

Received for publication November 4, 2003; revisions received December 17, 2003; accepted for publication December 31, 2003.

^* Address for reprints: Afksendiyos Kalangos, MD, PhD, Clinic for Cardiovascular Surgery, University Hospital of Geneva, 24, rue Micheli-du Crest, 1211 Geneva 17, Switzerland
Afksendyios.Kalangos{at}hcuge.ch

OBJECTIVE: Tricuspid valve replacement in children is associated with a nonnegligible complication rate because of specific disadvantages of mechanical or biologic prostheses. The objective of this study was to examine the midterm clinical outcomes of tricuspid valve replacement with a mitral homograft in 8 children with unreparable rheumatic tricuspid valve involvement.

METHODS: Between 1993 and 2003, tricuspid valve replacement with a mitral homograft was performed in 8 patients (2 male and 6 female patients; mean age, 14.2 years) with rheumatic tricuspid valve disease. All patients were in New York Heart Association class III or IV. In all patients with rheumatic valve disease, conservative operations had previously been performed on the tricuspid valve during concomitant left-sided surgical intervention. Mean follow-up was 56 ± 12 months and was complete.

RESULTS: There were no operative or late deaths. All patients were alive at the most recent follow-up contact and were in New York Heart Association functional class I or II. None of the patients required homograft-related reoperation. At the most recent echocardiograhic examination, 6 patients had trivial residual tricuspid regurgitation, and 2 had mild tricuspid regurgitation. None of the patients had maximal transvalvular tricuspid gradients greater than 2 mm Hg during their yearly follow-up visits.

CONCLUSION: On the basis of our midterm results, tricuspid valve replacement with a mitral homograft in children seems to be a valuable alternative surgical option.