title: Severe tricuspid regurgitation is predictive for adverse events in tetralogy of Fallot.
abstract: OBJECTIVE
  Patients with surgically repaired tetralogy of Fallot (rTOF) may develop functional tricuspid regurgitation (TR) due to annulus dilation. Guidelines suggest pulmonary valve replacement (PVR) in patients with rTOF with progressive TR, but data on clinical outcomes are lacking. Our objective was to determine whether TR was predictive for adverse events after PVR.
  
  
  METHODS
  In this retrospective, multicenter cohort study, patients with rTOF who had undergone PVR after preoperative echocardiographic assessment of TR grade were included. Preoperative and postoperative imaging data and a composite of adverse clinical events (death, sustained ventricular tachycardia, heart failure, or supraventricular tachycardia) were collected. Multivariate Cox hazards regression analysis was used to determine which factors were predictive for adverse events after PVR.
  
  
  RESULTS
  A total of 129 patients (61% men, age at PVR 32.9±10.4 years) were included. The composite endpoint occurred in 39 patients during 8.4±4.2 years of follow-up. In multivariate analysis, severe preoperative TR (HR 2.49, 95% CI 1.11 to 5.52), right ventricular end-systolic volume (HR 1.02/mL/m(2), 95% CI 1.01 to 1.03) and age at PVR (HR 1.07/year, 95% CI 1.04 to 1.09) were predictive for adverse events. Early postoperative TR was not predictive for adverse events (p=0.96). In patients without any risk factor (age >40 years, right ventricular end-systolic volume >90 mL/m(2) or severe TR), 5-year event-free survival was 100% as compared with 61% in patients with two or three risk factors.
  
  
  CONCLUSIONS
  In patients with rTOF, severe preoperative TR was predictive for adverse events after PVR. Close surveillance is warranted in these patients irrespective of postoperative TR.
authors.affiliation: Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands Interuniversity Cardiology Institute of the Netherlands.
authors.forename: Jouke P
authors.initials: JP
authors.lastname: Bokma
authors.affiliation: Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Michiel M
authors.initials: MM
authors.lastname: Winter
authors.affiliation: Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Thomas
authors.initials: T
authors.lastname: Oosterhof
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.affiliation: Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
authors.forename: Arie P
authors.initials: AP
authors.lastname: van Dijk
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Dave R
authors.initials: DR
authors.lastname: Koolbergen
authors.affiliation: Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Groenink
authors.affiliation: Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands Interuniversity Cardiology Institute of the Netherlands.
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
authors.affiliation: Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands Interuniversity Cardiology Institute of the Netherlands.
authors.forename: Berto J
authors.initials: BJ
authors.lastname: Bouma
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D016016:Proportional Hazards Models; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery; D011665:Pulmonary Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult