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 - Funding Information:
The authors thank Stéphanie Dionne (Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City), Sonia Iszcenko (Mazankowski Alberta Heart Institute, Edmonton), and Karen Withrow (Queen Elizabeth II Halifax Infirmary, Halifax) for their collaboration. Dr. Deshaies has been supported by a grant from the Dalhousie University Department of Surgery Research Office and by scholarships from the Canadian Institutes of Health Research (CIHR) and Fonds de recherche du Québec en Santé (FRQ-S). Dr. Trottier has been supported by CIHR New Investigator Salary and FRQ-S Junior 2 Research Scholar Awards. Dr. Khairy has been supported by the André Chagnon Research Chair in Adult Congenital Heart Disease. The study was carried out using CIHR funds held by Dr. Trottier and departmental funds from all collaborating centers. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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 -