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De Vega Tricuspid Annuloplasty for Pediatric Patients: Growth Potential of the Plicated Annulus

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Abstract

Although De Vega annuloplasty is an important option for pediatric patients with functional tricuspid regurgitation (TR), little is known about its long-term results, including the future of the plicated annulus. We retrospectively reviewed our experience with pediatric patients who underwent the De Vega annuloplasty between 2005 and 2020. Tricuspid valve assessments were performed by transthoracic echocardiography. The targeted diameter of annular plication was 80 to 90% of normal tricuspid diameter, according to the patient's condition. The study included 55 patients (41 with biventricular physiology (group B), 14 with univentricular physiology (group U)) with a median follow-up of 5.0 years. Median age at operation was 5.0 years. There was one late death due to severe mitral regurgitation. Tricuspid valve reoperation was required in five patients and the 10-year freedom from reoperation was 91.9% for the entire cohort. The 10-year freedom from the composite adverse outcome of death, reoperation, and significant TR was 79.2% in group B versus 56.6% in group U (p = 0.034). TR grade significantly decreased after surgery (p < 0.001), without significant aggravation during the postoperative follow-up. No patients presented tricuspid stenosis. Mean Z-scores of annular diameter immediately after operation and at the latest follow-up were − 0.65 ± 0.56 versus − 0.47 ± 0.65 (p = 0.57). De Vega annuloplasty is a safe, efficient, and durable procedure for functional TR in pediatric patients including those with univentricular physiology, allowing adequate growth of the plicated annulus without the progression of tricuspid stenosis.

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Data Availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Acknowledgements

The authors are grateful to N. Fujiwara for his constructive suggestions on statistical analysis.

Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Department of Pediatric Cardiovascular Surgery, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu-city, Tokyo, 183-8561, Japan

    Yusuke Yamamoto

  2. Department of Pediatric Cardiovascular Surgery, Saitama Children’s Medical Center, 1-2 Shintoshin, Saitama-city, Saitama, 330-8777, Japan

    Koji Nomura, Fumiaki Murayama & Sho Isobe

  3. Department of Pediatric Cardiology, Saitama Children’s Medical Center, 1-2 Shintoshin, Saitama-city, Saitama, 330-8777, Japan

    Kenji Hoshino

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  1. Yusuke Yamamoto
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  2. Koji Nomura
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  3. Fumiaki Murayama
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  4. Sho Isobe
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  5. Kenji Hoshino
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Contributions

YY conceived and designed the study, analyzed the data, wrote the manuscript, and revised it. KN, FM, and SI collected and analyzed the data and helped in revision of manuscript. KH helped in the final drafting of the manuscript.

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Correspondence to Yusuke Yamamoto.

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All authors declare that they have no conflicts of interest.

Ethical Approval

This study was conducted with the approval of the institutional review board of Saitama Children's Medical Center (#2020-05-004, January 14, 2021).

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All authors have nothing to disclose.

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A written informed consent was obtained from one or both parents of all patients.

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Yamamoto, Y., Nomura, K., Murayama, F. et al. De Vega Tricuspid Annuloplasty for Pediatric Patients: Growth Potential of the Plicated Annulus. Pediatr Cardiol 42, 1854–1861 (2021). https://doi.org/10.1007/s00246-021-02679-x

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  • DOI: https://doi.org/10.1007/s00246-021-02679-x

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