Tricuspid Intervention Following Pulmonary Valve Replacement in Adults With Congenital Heart Disease.
J Am Coll Cardiol
; 75(9): 1033-1043, 2020 03 10.
Article
em En
| MEDLINE
| ID: mdl-32138963
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Estenose da Valva Pulmonar
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Insuficiência da Valva Tricúspide
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Implante de Prótese de Valva Cardíaca
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Cardiopatias Congênitas
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Child
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Child, preschool
/
Female
/
Humans
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Infant
/
Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Am Coll Cardiol
Ano de publicação:
2020
Tipo de documento:
Article