Transcatheter Pulmonary Valve Replacement Reduces Tricuspid Regurgitation in Patients With Right Ventricular Volume/Pressure Overload.
Tricuspid regurgitation (TR) is a common and important comorbidity in patients with postoperative right ventricular outflow tract (RVOT) obstruction or pulmonary regurgitation (PR). Transcatheter pulmonary valve replacement (TPVR) has become a useful tool in the management of postoperative RVOT obstruction and PR, but it is unknown whether relief of the right ventricular volume and/or pressure overload by TPVR will have a beneficial effect on TR, as is often seen with surgical pulmonary valve replacement.



This study sought to assess the prevalence of and factors associated with significant TR in patients undergoing TPVR for RVOT obstruction or PR.



Data were combined from 3 prospective multicenter trials of patients referred for TPVR. Follow-up data through 5 years post-implantation were analyzed.



Of 300 patients studied, 77 (25.6%) had moderate or severe TR at baseline. After TPVR, TR severity was improved in 65% of those patients, and more than one-half had mild TR or less TR at discharge. Of 13 patients with severe TR pre-implantation, only 1 had severe TR at 1-year follow-up and beyond. Moderate or severe baseline TR was associated with shorter freedom from RVOT reintervention after TPVR.



In this prospective multicenter study of post-operative patients with RVOT obstruction and/or PR, TR was common. In patients with significant baseline TR, TPVR resulted in clinically relevant acute reductions in TR that persisted over at least 5 years of follow-up. These observations support the application of TPVR therapy in patients with RVOT obstruction or PR who are anatomically suitable, even in the setting of significant concomitant TR.
Seattle Children's Hospital, Seattle, Washington.
Thomas K
TK
Jones
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Jonathan J
JJ
Rome
Nationwide Children's Hospital, Columbus, Ohio.
Aimee K
AK
Armstrong
Deutsches Herzzentrum Berlin and Charité-Universitaetsmedizin Berlin, Berlin, Germany.
Felix
F
Berger
Yale University School of Medicine, New Haven, Connecticut.
William E
WE
Hellenbrand
Mayo Clinic College of Medicine, Rochester, Minnesota.
Allison K
AK
Cabalka
The Hospital for Sick Children, Toronto, Canada.
Lee N
LN
Benson
St. Louis Children's Hospital, St. Louis, Missouri.
David T
DT
Balzer
Nationwide Children's Hospital, Columbus, Ohio.
John P
JP
Cheatham
German Heart Center Munich, Munich, Germany.
Andreas
A
Eicken
Lucille Packard Children's Hospital Stanford, Palo Alto, California. Electronic address: doffmcelhinney@gmail.com.
Doff B
DB
McElhinney
D000293:Adolescent; D000328:Adult; D002648:Child; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000150:complications / Q000601:surgery*; D012720:Severity of Illness Index; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000601:surgery*; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000601:surgery*; D055815:Young Adult
catheterization; cohort studies; congenital; heart defects; percutaneous valve; prospective studies; tetralogy of Fallot