TY - JOUR
T1 - Tricuspid Intervention Following Pulmonary Valve Replacement in Adults With Congenital Heart Disease
AU - Canadian Congenital Cardiac Collaborative (4C)
AU - Deshaies, Catherine
AU - Trottier, Helen
AU - Khairy, Paul
AU - Al-Aklabi, Mohammed
AU - Beauchesne, Luc
AU - Bernier, Pierre Luc
AU - Dhillon, Santokh
AU - Gandhi, Sanjiv K.
AU - Haller, Christoph
AU - Hancock Friesen, Camille L.
AU - Hickey, Edward J.
AU - Horne, David
AU - Jacques, Frédéric
AU - Kiess, Marla C.
AU - Perron, Jean
AU - Rodriguez, Maria
AU - Poirier, Nancy C.
N1 - Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/3/10
Y1 - 2020/3/10
N2 - Background: Tricuspid regurgitation (TR) is common among adults with corrected tetralogy of Fallot (TOF) or pulmonary stenosis (PS) referred for pulmonary valve replacement (PVR). Yet, combined valve surgery remains controversial. Objectives: This study sought to evaluate the impact of concomitant tricuspid valve intervention (TVI) on post-operative TR, length of hospital stay, and on a composite endpoint consisting of 7 early adverse events (death, reintervention, cardiac electronic device implantation, infection, thromboembolic event, hemodialysis, and readmission). Methods: The national Canadian cohort enrolled 542 patients with TOF or PS and mild to severe TR who underwent isolated PVR (66.8%) or PVR+TVI (33.2%). Outcomes were abstracted from charts and compared between groups using multivariable logistic and negative binomial regression. Results: Median age at reintervention was 35.3 years. Regardless of surgery type, TR decreased by at least 1 echocardiographic grade in 35.4%, 66.9%, and 92.8% of patients with pre-operative mild, moderate, and severe insufficiency. In multivariable analyses, PVR+TVI was associated with an additional 2.3-fold reduction in TR grade (odds ratio [OR]: 0.44; 95% confidence interval [CI]: 0.25 to 0.77) without an increase in early adverse events (OR: 0.85; 95% CI: 0.46 to 1.57) or hospitalization time (incidence rate ratio: 1.17; 95% CI: 0.93 to 1.46). Pre-operative TR severity and presence of transvalvular leads independently predicted post-operative TR. In contrast, early adverse events were strongly associated with atrial tachyarrhythmia, extracardiac arteriopathy, and a high body mass index. Conclusions: In patients with TOF or PS and significant TR, concomitant TVI is safe and results in better early tricuspid valve competence than isolated PVR.
AB - Background: Tricuspid regurgitation (TR) is common among adults with corrected tetralogy of Fallot (TOF) or pulmonary stenosis (PS) referred for pulmonary valve replacement (PVR). Yet, combined valve surgery remains controversial. Objectives: This study sought to evaluate the impact of concomitant tricuspid valve intervention (TVI) on post-operative TR, length of hospital stay, and on a composite endpoint consisting of 7 early adverse events (death, reintervention, cardiac electronic device implantation, infection, thromboembolic event, hemodialysis, and readmission). Methods: The national Canadian cohort enrolled 542 patients with TOF or PS and mild to severe TR who underwent isolated PVR (66.8%) or PVR+TVI (33.2%). Outcomes were abstracted from charts and compared between groups using multivariable logistic and negative binomial regression. Results: Median age at reintervention was 35.3 years. Regardless of surgery type, TR decreased by at least 1 echocardiographic grade in 35.4%, 66.9%, and 92.8% of patients with pre-operative mild, moderate, and severe insufficiency. In multivariable analyses, PVR+TVI was associated with an additional 2.3-fold reduction in TR grade (odds ratio [OR]: 0.44; 95% confidence interval [CI]: 0.25 to 0.77) without an increase in early adverse events (OR: 0.85; 95% CI: 0.46 to 1.57) or hospitalization time (incidence rate ratio: 1.17; 95% CI: 0.93 to 1.46). Pre-operative TR severity and presence of transvalvular leads independently predicted post-operative TR. In contrast, early adverse events were strongly associated with atrial tachyarrhythmia, extracardiac arteriopathy, and a high body mass index. Conclusions: In patients with TOF or PS and significant TR, concomitant TVI is safe and results in better early tricuspid valve competence than isolated PVR.
KW - congenital cardiac surgery
KW - pulmonary stenosis
KW - tetralogy of Fallot
KW - tricuspid regurgitation
KW - tricuspid valve repair
KW - tricuspid valve replacement
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U2 - 10.1016/j.jacc.2019.12.053
DO - 10.1016/j.jacc.2019.12.053
M3 - Article
C2 - 32138963
AN - SCOPUS:85079885288
SN - 0735-1097
VL - 75
SP - 1033
EP - 1043
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 9
ER -