Tricuspid Intervention Following Pulmonary Valve Replacement in Adults With Congenital Heart Disease

Deshaies, Catherine; Trottier, Helen; Khairy, Paul; Al-Aklabi, Mohammed; Beauchesne, Luc; Bernier, Paule; Dhillon, Santokh; Gandhi, Sanjiv K.; Haller, Christoph; Friesen, Camille L. Hancock; Hickey, Edward; Horne, David; Jacques, Frédéric; Kiess, Marla; Perron, Jean; Rodriguez, Maria Lorena; Poirier, Nancy

doi:10.1016/j.jacc.2019.12.053

Cited by 17 publications

(16 citation statements)

References 36 publications

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“…This study similarly found no patients with residual moderate or greater TR in the TVI+PVR group, compared with 78% (7/9) of those with PVR alone when analyzing patients with severe TR before surgery. In accordance with this, Deshaies et al 16 found that severe preoperative TR was associated with a higher risk of residual postoperative TR (OR, 9.43; 95% CI, 4.20–21.33; P <0.001), while TVI+PVR reduced this risk (OR, 0.44; 95% CI, 0.25–0.77; P =0.004). Importantly, only 5.6% (4/72) of patients with severe preoperative TR underwent isolated PVR in this study.…”

Section: Discussionmentioning

confidence: 62%

“…Notably, all of these findings were drawn from single‐center studies composed of relatively small populations. Conversely, results from a multicenter study performed by Deshaies et al 16 found that TVI+PVR results in a greater reduction in TR. With the exception of a slightly higher incidence of major infections, there was no evidence for differences in adverse outcomes between TVI+PVR and PVR alone.…”

Section: Discussionmentioning

confidence: 84%

“…Kogon et al 21 intervened on 46% (16/35) of patients with moderate or greater TR, stating bias toward a conservative approach based on their prior work 26 showing improvement in TV function without concomitant TVI, a view shared by Cramer et al 20 In contrast, Taejung Kim et al 17 performed concomitant TVI in 56.7% (38/67) of patients in their cohort, with no signficant difference in baseline TV annulus diameter but larger RV volumes in their TVI+PVR group, reflecting a more aggressive approach to TR at their center. In Deshaies et al, 16 almost 59.8% (158/264) of patients with moderate or greater TR had TVI+PVR, as opposed to only 7.9% (22/278) of those with mild TR. Taken together, these data suggest that considerable heterogeneity may have been present with regard to indications for concomitant TVI.…”

Section: Discussionmentioning

confidence: 86%

“…A total of 2031 citations were identified, of which 46 studies were potentially relevant and retrieved as full text. Six publications 16 , 17 , 18 , 19 , 20 , 21 fulfilled our eligibility criteria (Figure 1 ). Characteristics of each study and their patients are shown in Tables 1 , 2 , 3 .…”

Section: Resultsmentioning

confidence: 99%

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Tricuspid Valve Intervention at the Time of Pulmonary Valve Replacement in Adults With Congenital Heart Disease: A Systematic Review and Meta‐Analysis

Eynde

Callahan

Rito

et al. 2021

JAHA

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Background Tricuspid regurgitation (TR) is a common finding in adults with congenital heart disease referred for pulmonary valve replacement (PVR). However, indications for combined valve surgery remain controversial. This study aimed to evaluate early results of concomitant tricuspid valve intervention (TVI) at the time of PVR. Methods and Results Observational studies comparing TVI+PVR and isolated PVR were identified by a systematic search of published research. Random‐effects meta‐analysis was performed, comparing outcomes between the 2 groups. Six studies involving 749 patients (TVI+PVR, 278 patients; PVR, 471 patients) met the eligibility criteria. In the pooled analysis, both TVI+PVR and PVR reduced TR grade, pulmonary regurgitation grade, right ventricular end‐diastolic volume, and right ventricular end‐systolic volumes. TVI+PVR, but not PVR, was associated with a decrease in tricuspid valve annulus size (mean difference, −6.43 mm, 95% CI, −10.59 to −2.27; P =0.010). Furthermore, TVI+PVR was associated with a larger reduction in TR grade compared with PVR (mean difference, −0.40; 95% CI, −0.75 to −0.05; P =0.031). No evidence could be established for an effect of either treatment on right ventricular ejection fraction or echocardiographic assessment of right ventricular dilatation and dysfunction. There was no evidence for a difference in hospital mortality or reoperation for TR. Conclusions While both strategies are effective in reducing TR and right ventricular volumes, routine TVI+PVR can reduce TR grade to a larger extent than isolated PVR. Further studies are needed to identify the subgroups of patients who might benefit most from combined valve surgery.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Tricuspid Valve Intervention at the Time of Pulmonary Valve Replacement in Adults With Congenital Heart Disease: A Systematic Review and Meta‐Analysis

Eynde

Callahan

Rito

et al. 2021

JAHA

View full text Add to dashboard Cite

show abstract

“…These notions2 3 might also apply to the setting of r-TOF with a significant pulmonary infundibular or valvular pathology (associated with right ventricular (RV) pressure or volume overload) requiring reintervention. In the recently reported largest study comprising 542 subjects with r-TOF or pulmonary stenosis requiring PVR, concomitant tricuspid valve intervention (TVI) led to an additional 2.3-fold decrease in TR severity without any significant increases in length of hospital stay and early adverse outcomes 4. The authors particularly suggested concomitant TVI as an efficient and safe option that might further improve TR grade beyond the favourable impact of RV offloading obtained with PVR in isolation 4.…”

mentioning

confidence: 99%