Valve Outcomes in Temporary Tricuspid Valve Detachment for Transatrial Ventricular Septal Defect Closure

Background In ventricular septal defect (VSD) closure, accurately defining the margins of the VSD is essential for success. Transatrial tricuspid valve detachment (TVD) aims at improving visualization, which is often impaired by the tricuspid valve apparatus. However, this may affect operative time, atrioventricular (AV) conduction, and tricuspid valve function. Methods All pediatric patients who underwent transatrial isolated VSD closure from 2011 to 2020 were studied. Based on the use of TVD, postoperative outcomes, including tricuspid valve function, incidence of residual VSD and postoperative heart block, were compared between the two groups. Results Of 268 patients, 88 (32.8%) underwent VSD closure with TVD and 180 (67.2%) without TVD. Preoperative characteristics were similar, including median age and weight (13.5 vs 12.5 months and 7 vs 6.9 kg; P = .98 and P = .60). The VSDs were predominantly perimembranous (83% [73/88] vs 88.3% [159/180]; P = .17), and of similar size (7.8 vs 7.5 mm; P = .32). There were no significant differences in the degree of postoperative tricuspid regurgitation (TR) (>mild 7.1% [6/84] vs 5% [9/180]; P = .38), small residual VSD (11.9% [10/84] vs [35/180] 19.6%; P = .12), or incidence of transient heart block (2.3% [2/84] vs 4.4% [8/179]; P = .38). At the median follow-up time of 38.3 months, there were no reoperations for TR nor residual VSD. Only one patient from the non-TVD group needed a reoperation for a permanent pacemaker. The cardiopulmonary bypass and cross-clamp times were longer in the TVD group (70 ± 25 vs 61 ± 19 min; P = .002) and (50 ± 18 vs 40 ± 15 min; P < .001). Conclusions The tricuspid valve detachment technique for VSD closure is associated with comparable postoperative tricuspid valve function and AV conduction when compared with nondetachment techniques. It is a safe and effective approach for challenging-to-assess transatrial VSD closures.