Catherine Deshaies1, Helen Trottier2, Paul Khairy3, Mohammed Al-Aklabi4, Luc Beauchesne5, Pierre-Luc Bernier6, Santokh Dhillon7, Sanjiv K Gandhi8, Christoph Haller9, Camille L Hancock Friesen10, Edward J Hickey9, David Horne10, Frédéric Jacques11, Marla C Kiess8, Jean Perron11, Maria Rodriguez5, Nancy C Poirier12. 1. Queen Elizabeth II Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada; Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Centre hospitalier universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada. Electronic address: catherine.deshaies@mail.mcgill.ca. 2. Centre hospitalier universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada. 3. Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada. 4. Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. 5. University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada. 6. Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada. 7. Izaak Walton Killam Health Center, Dalhousie University, Halifax, Nova Scotia, Canada. 8. St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 9. Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. 10. Queen Elizabeth II Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada; Izaak Walton Killam Health Center, Dalhousie University, Halifax, Nova Scotia, Canada. 11. Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada. 12. Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Centre hospitalier universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
Abstract
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.
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.
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