Thomas K Jones1, Jonathan J Rome2, Aimee K Armstrong3, Felix Berger4, William E Hellenbrand5, Allison K Cabalka6, Lee N Benson7, David T Balzer8, John P Cheatham3, Andreas Eicken9, Doff B McElhinney10. 1. Seattle Children's Hospital, Seattle, Washington. 2. The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 3. Nationwide Children's Hospital, Columbus, Ohio. 4. Deutsches Herzzentrum Berlin and Charité-Universitaetsmedizin Berlin, Berlin, Germany. 5. Yale University School of Medicine, New Haven, Connecticut. 6. Mayo Clinic College of Medicine, Rochester, Minnesota. 7. The Hospital for Sick Children, Toronto, Canada. 8. St. Louis Children's Hospital, St. Louis, Missouri. 9. German Heart Center Munich, Munich, Germany. 10. Lucille Packard Children's Hospital Stanford, Palo Alto, California. Electronic address: doffmcelhinney@gmail.com.
Abstract
BACKGROUND: Tricuspid regurgitation (TR) is a common and important comorbidity in patients with postoperative right ventricular outflow tract (RVOT) obstruction or pulmonary regurgitation (PR). Transcatheter pulmonary valve replacement (TPVR) has become a useful tool in the management of postoperative RVOT obstruction and PR, but it is unknown whether relief of the right ventricular volume and/or pressure overload by TPVR will have a beneficial effect on TR, as is often seen with surgical pulmonary valve replacement. OBJECTIVES: This study sought to assess the prevalence of and factors associated with significant TR in patients undergoing TPVR for RVOT obstruction or PR. METHODS: Data were combined from 3 prospective multicenter trials of patients referred for TPVR. Follow-up data through 5 years post-implantation were analyzed. RESULTS: Of 300 patients studied, 77 (25.6%) had moderate or severe TR at baseline. After TPVR, TR severity was improved in 65% of those patients, and more than one-half had mild TR or less TR at discharge. Of 13 patients with severe TR pre-implantation, only 1 had severe TR at 1-year follow-up and beyond. Moderate or severe baseline TR was associated with shorter freedom from RVOT reintervention after TPVR. CONCLUSIONS: In this prospective multicenter study of post-operative patients with RVOT obstruction and/or PR, TR was common. In patients with significant baseline TR, TPVR resulted in clinically relevant acute reductions in TR that persisted over at least 5 years of follow-up. These observations support the application of TPVR therapy in patients with RVOT obstruction or PR who are anatomically suitable, even in the setting of significant concomitant TR.
BACKGROUND:Tricuspid regurgitation (TR) is a common and important comorbidity in patients with postoperative right ventricular outflow tract (RVOT) obstruction or pulmonary regurgitation (PR). Transcatheter pulmonary valve replacement (TPVR) has become a useful tool in the management of postoperative RVOT obstruction and PR, but it is unknown whether relief of the right ventricular volume and/or pressure overload by TPVR will have a beneficial effect on TR, as is often seen with surgical pulmonary valve replacement. OBJECTIVES: This study sought to assess the prevalence of and factors associated with significant TR in patients undergoing TPVR for RVOT obstruction or PR. METHODS: Data were combined from 3 prospective multicenter trials of patients referred for TPVR. Follow-up data through 5 years post-implantation were analyzed. RESULTS: Of 300 patients studied, 77 (25.6%) had moderate or severe TR at baseline. After TPVR, TR severity was improved in 65% of those patients, and more than one-half had mild TR or less TR at discharge. Of 13 patients with severe TR pre-implantation, only 1 had severe TR at 1-year follow-up and beyond. Moderate or severe baseline TR was associated with shorter freedom from RVOT reintervention after TPVR. CONCLUSIONS: In this prospective multicenter study of post-operative patients with RVOT obstruction and/or PR, TR was common. In patients with significant baseline TR, TPVR resulted in clinically relevant acute reductions in TR that persisted over at least 5 years of follow-up. These observations support the application of TPVR therapy in patients with RVOT obstruction or PR who are anatomically suitable, even in the setting of significant concomitant TR.
Authors: Antonio F Corno; Alan G Dawson; Aidan P Bolger; Branco Mimic; Suhair O Shebani; Gregory J Skinner; Simone Speggiorin Journal: Nano Rev Exp Date: 2017-05-01
Authors: Thomas K Jones; Doff B McElhinney; Julie A Vincent; William E Hellenbrand; John P Cheatham; Darren P Berman; Evan M Zahn; Danyal M Khan; John F Rhodes; Shicheng Weng; Lisa J Bergersen Journal: Circ Cardiovasc Interv Date: 2021-12-21 Impact factor: 6.546
Authors: Jef Van den Eynde; Connor P Callahan; Mauro Lo Rito; Nabil Hussein; Horacio Carvajal; Alvise Guariento; Arjang Ruhparwar; Alexander Weymann; Werner Budts; Marc Gewillig; Michel Pompeu Sá; Shelby Kutty Journal: J Am Heart Assoc Date: 2021-12-07 Impact factor: 6.106