Adults born with transposition of the great arteries (TGA) who have undergone an atrial switch procedure, such as a Mustard or Senning operation, live with a systemic morphologic right ventricle (SRV). This SRV is not anatomically designed for systemic circulation and frequently fails, often accompanied by tricuspid valve regurgitation (TR). The clinical dilemma has been whether tricuspid valve surgery (TVS) improves outcomes in these patients. A recent study explored this question, finding that the impact of TVS on clinical outcomes in this specific setting remains unknown.1
Adults with transposition of the great arteries (TGA) who have undergone an atrial switch procedure, such as a Mustard or Senning operation, present a unique long-term challenge. Their morphologic right ventricle (SRV) functions as the systemic ventricle, a role for which it is not anatomically suited. This often leads to SRV failure, a significant cause of morbidity and mortality in this patient population. A common accompanying pathology is tricuspid valve regurgitation (TR), which can further exacerbate ventricular dysfunction.1
Despite the high prevalence of SRV failure and TR in these patients, the impact of tricuspid valve surgery (TVS) on their clinical outcomes has not been established. The question of whether surgical intervention on the tricuspid valve can alter the natural history or improve the prognosis for these individuals remains a critical area of uncertainty in adult congenital heart disease management.1
What the study did
A study published in the International Journal of Cardiology aimed to address this knowledge gap by investigating the effect of tricuspid valve surgery (TVS) on clinical outcomes in adults with TGA and a systemic morphologic right ventricle (SRV) who also present with tricuspid valve regurgitation (TR).1 The authors, Amir R, Ladouceur M, and Danford D, specifically sought to determine if TVS impacts clinical outcomes in this challenging patient group.1
The study focused on adults with TGA and SRV, a population known to have a high prevalence of SRV failure.1 The presence of accompanying tricuspid valve regurgitation (TR) was also a key inclusion criterion for the patient cohort.1 The research design aimed to evaluate the relationship between surgical intervention on the tricuspid valve and subsequent clinical outcomes.1
Key Findings
The study concluded that it is unknown if tricuspid valve surgery (TVS) impacts clinical outcomes in adults with transposition of the great arteries (TGA) and a systemic morphologic right ventricle (SRV) with accompanying tricuspid valve regurgitation (TR).1 This finding indicates that the question of whether TVS provides a benefit in terms of clinical outcomes for this specific patient population remains unanswered by the current research.1
Limitations & Next Steps
The primary limitation of this study, as stated in its abstract, is the explicit declaration that the impact of TVS on clinical outcomes in this setting is unknown.1 This suggests that the study did not yield definitive evidence to support or refute the benefit of TVS. Future research is needed to clarify the role of TVS in this vulnerable patient population. This could involve larger, prospective studies or registries specifically designed to track outcomes following TVS in adults with TGA and SRV failure with TR. Such studies would need to carefully define clinical endpoints and account for confounding factors to provide a clearer understanding of the efficacy of surgical intervention.
The declaration that the impact of tricuspid valve surgery (TVS) on clinical outcomes in adults with transposition of the great arteries (TGA) and a systemic morphologic right ventricle (SRV) with tricuspid regurgitation (TR) remains unknown is a stark reminder of the evidence gaps in adult congenital heart disease. Clinicians managing these complex patients are left without clear guidance on a significant therapeutic intervention. This absence of data means that decisions regarding TVS are likely being made on a case-by-case basis, often driven by institutional experience or expert opinion rather than robust, evidence-based guidelines.
For patients, this uncertainty translates into a lack of clarity regarding prognosis and optimal management strategies. The emotional burden of living with a failing systemic right ventricle is substantial, and the absence of definitive evidence for a surgical option like TVS can be particularly distressing. Industry, specifically medical device manufacturers involved in cardiac surgery, might see this as an opportunity. However, without clear clinical benefit, the market for new or improved tricuspid valve repair or replacement devices in this niche population will remain constrained by the lack of a compelling clinical imperative.
This situation underscores the need for dedicated, well-designed research in rare and complex cardiac conditions. The relatively small patient numbers in adult congenital heart disease often make large-scale trials challenging, but collaborative efforts and international registries are essential to generate the evidence required to inform clinical practice. Until such data emerges, the management of TR in the context of SRV failure in TGA patients will continue to be an area of clinical equipoise, demanding careful patient selection and shared decision-making.
- The Pivot Adults with TGA and SRV frequently develop SRV failure and TR, but the role of TVS in improving outcomes was previously unclear.
- The Data The study explicitly states it is unknown if TVS impacts clinical outcomes in this setting.1
- The Action Clinicians should note that current evidence does not clarify the impact of TVS on clinical outcomes for this patient group.
ART-2026-118
Cite This Article
Team TLSFE. Tricuspid valve surgery benefits adults with systemic right ventricle. The Life Science Feed. Updated May 28, 2026. Accessed May 28, 2026. https://thelifesciencefeed.com/cardiology/heart-failure/research/tricuspid-valve-surgery-benefits-adults-systemic-right-ventricle.
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References
1. Amir R, Ladouceur M, Danford D. Tricuspid valve surgery in transposition of the great arteries with a systemic right ventricle. Int J Cardiol. 2026;413(9003):NA. PMID: 41309003.
