Tricuspid regurgitation severity after atrial septal defect closure or pulmonic valve replacement

Abstract

ObjectivesCardiac surgery or catheter interventions are nowadays commonly performed to reduce volume loading of the right ventricle in adults with congenital heart disease. However, little is known, on the effect of such procedures on pre-existing tricuspid regurgitation (TR). We assessed the potential reduction in the severity of TR after atrial septal defect (ASD) closure and pulmonic valve replacement (PVR).MethodsDemographics, clinical and echocardiographic characteristics of consecutive patients undergoing ASD closure or PVR between 2005 and 2014 at a single centre who had at least mild preoperative TR were collected and analysed.ResultsOverall, 162 patients (mean age at intervention 41.6±16.1 years, 38.3% male) were included: 101 after ASD closure (61 transcatheter vs 40 surgical) and 61 after PVR (3 transcatheter vs 58 surgical). Only 11.1% received concomitant tricuspid valve surgery (repair). There was significant reduction in the severity of TR in the overall population, from 38 (23.5%) patients having moderate or severe TR preoperatively to only 11 (6.8%) and 20 (12.3%) at 6 months and 12 months of follow-up, respectively (McNemar p<0.0001). There was a significant reduction in tricuspid valve annular diameter (p<0.0001), coaptation distance (p<0.0001) and systolic tenting area (p<0.0001). The reduction in TR was also observed in patients who did not have concomitant tricuspid valve (TV) repair (from 15.3% to 6.9% and 11.8% at 6 and 12 months, respectively, p<0.0001). On multivariable logistic regression including all univariable predictors of residual TR at 12 months, only RA area remained in the model (OR 1.2, 95% CI 1.04 to 1.37, p=0.01).ConclusionsASD closure and PVR are associated with a significant reduction in tricuspid regurgitation, even among patients who do not undergo concomitant tricuspid valve surgery.

Transcatheter versus surgical closure of atrial septal defect in adult patients with tricuspid regurgitation

“…Previous studies reported that pulmonary artery systolic pressure, right atrial area and persistent atrial fibrillation were predictors of significant residual TR after ASD closure alone in patients with moderate-to-severe TR 10 11 13 14 23. While those variables were also associated with the significant residual TR in our univariable analyses, only TAP and ASD maximal diameter were found to be independent predictors in multivariable analysis.…”

Outcomes and risk analysis after tricuspid valve surgery for non-Ebstein 2-ventricle congenital tricuspid valve diseases

“…The incidence of TR deemed moderate or greater after 5 years of follow-up was 34%. Similarly, Martin-Garcia and colleagues 23 reported that the incidence of moderate to severe TR was 11% at 1 year of follow-up for patients undergoing concomitant TV intervention at the time of atrial septal defect repair or pulmonary valve replacement. Similarly, The The Surgical Correction Of Tricuspid Insufficiency in Adult congenital patients requiring Pulmonary Valve Replacement (SCOTIA-PVR) trial sought to evaluate the influence of TV intervention on 542 adults with congenital heart disease undergoing pulmonary valve replacement.…”

Clinical significance of right ventricular–pulmonary arterial coupling in patients with tricuspid regurgitation before closure of atrial septal defect

“…Furthermore, pulmonary hypertension before ASD closure was associated with persistent TR after ASD closure (2). In a long-term follow-up study, significant TR decreased during the long-term follow-up period after transcatheter ASD closure, along with an improvement in heart failure symptoms (6,15). However, even in long-term follow-up studies, significant TR persisted in approximately 20% of patients (6,15).…”