{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T15:56:14Z","timestamp":1765209374830,"version":"3.46.0"},"reference-count":19,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Moscow Center for healthcare innovations","award":["2002-25\/23"],"award-info":[{"award-number":["2002-25\/23"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>(1) Background: The systemic right ventricular (SRV) dysfunction and severe tricuspid regurgitation (TR) remain significant challenges in patients with congenitally corrected transposition of the great arteries (ccTGA) or following atrial switch procedures. Currently, there is no established, evidence-based medical therapy specifically designed for SRV failure, and treatment approaches are largely extrapolated from left ventricular heart failure (HF) guidelines. This therapeutic gap highlights the need for tailored pharmacologic strategies and optimized perioperative management in this unique population. The optimal timing of surgical intervention and the role of modern HF therapy are still under active investigation. (2) Methods: We present a case series of four patients (three adults and one child) with SRV dysfunction and severe TR, who underwent staged treatment consisting of optimized medical therapy followed by surgical tricuspid valve (TV) replacement. Medical therapy included positive inotropes, sacubitril\/valsartan, sodium-glucose co-transporter 2 inhibitors (iSGLT2), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and loop diuretics. (3) Results: All patients demonstrated clinical and hemodynamic improvement prior to surgery, with an increase in systemic ventricular ejection fraction (SVEF &gt; 40%) and cardiac index. TV replacement was performed with favorable early postoperative outcomes and preserved ventricular function at mid-term follow-up. No mortality or major adverse events occurred during follow-up. One case of acute cystitis was associated with dapagliflozin. In all patients, postoperative SVEF remained &gt;40%, and no recurrence of significant TR was observed. (4) Conclusions: A stepwise approach combining modern heart failure therapy and elective TV replacement in patients with SRV dysfunction and TR is safe and effective. Preoperative optimization leads to improved ventricular function and may enhance surgical outcomes. These findings support the integration of contemporary pharmacotherapy in the management strategy for SRV failure.<\/jats:p>","DOI":"10.3390\/jcdd12120482","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T14:52:24Z","timestamp":1765205544000},"page":"482","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reduced Ejection Fraction of the Systemic Right Ventricle and Severe Tricuspid Regurgitation: Medication or Surgery?"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6456-1905","authenticated-orcid":false,"given":"Anton V.","family":"Minaev","sequence":"first","affiliation":[{"name":"Congenital Heart Diseases Department, Federal State Budgetary Institution \u201cNational Medical Research Center of Cardiovascular Surgery Named After A.N. Bakulev\u201d, Ministry of Health of the Russian Federation, Rublevskoe Shosse 135, 121552 Moscow, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timur Y.","family":"Danilov","sequence":"additional","affiliation":[{"name":"Congenital Heart Diseases Department, Federal State Budgetary Institution \u201cNational Medical Research Center of Cardiovascular Surgery Named After A.N. Bakulev\u201d, Ministry of Health of the Russian Federation, Rublevskoe Shosse 135, 121552 Moscow, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7723-9872","authenticated-orcid":false,"given":"Diana P.","family":"Paraskevova","sequence":"additional","affiliation":[{"name":"Congenital Heart Diseases Department, Federal State Budgetary Institution \u201cNational Medical Research Center of Cardiovascular Surgery Named After A.N. Bakulev\u201d, Ministry of Health of the Russian Federation, Rublevskoe Shosse 135, 121552 Moscow, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vera I.","family":"Dontsova","sequence":"additional","affiliation":[{"name":"Congenital Heart Diseases Department, Federal State Budgetary Institution \u201cNational Medical Research Center of Cardiovascular Surgery Named After A.N. Bakulev\u201d, Ministry of Health of the Russian Federation, Rublevskoe Shosse 135, 121552 Moscow, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inna I.","family":"Trunina","sequence":"additional","affiliation":[{"name":"Cardiology Department, Moscow State Budgetary Healthcare Institution \u201cChildren\u2019s City Clinical Hospital Named After Z.A. Bashlyaeva, Moscow City Health Department\u201d, Schelyapovoy St. 11, 123098 Moscow, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viktor B.","family":"Samsonov","sequence":"additional","affiliation":[{"name":"Congenital Heart Diseases Department, Federal State Budgetary Institution \u201cNational Medical Research Center of Cardiovascular Surgery Named After A.N. Bakulev\u201d, Ministry of Health of the Russian Federation, Rublevskoe Shosse 135, 121552 Moscow, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofya M.","family":"Tsoy","sequence":"additional","affiliation":[{"name":"Congenital Heart Diseases Department, Federal State Budgetary Institution \u201cNational Medical Research Center of Cardiovascular Surgery Named After A.N. Bakulev\u201d, Ministry of Health of the Russian Federation, Rublevskoe Shosse 135, 121552 Moscow, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander S.","family":"Voynov","sequence":"additional","affiliation":[{"name":"Consultative and Diagnostic Department, State Budgetary Healthcare Institution \u201cCity Polyclinic No. 67 of the Moscow Department of Healthcare\u201d, Varshavskoye Shosse 19, 117105 Moscow, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia A.","family":"Sarkisyan","sequence":"additional","affiliation":[{"name":"Cardiology Department, State Budgetary Healthcare Institution \u201cCity Polyclinic No. 220 of the Moscow Department of Healthcare\u201d, Filevsky Bulvar 18, 121601 Moscow, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e029706","DOI":"10.1161\/JAHA.122.029706","article-title":"Congenitally Corrected Transposition of the Great Arteries: Fetal Diagnosis, Associations, and Postnatal Outcome: A Fetal Heart Society Research Collaborative Study","volume":"12","author":"Cohen","year":"2023","journal-title":"J. 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