Severe preoperative tricuspid regurgitation was independently predictive for adverse clinical events after pulmonary valve replacement in patients with repaired tetralogy of Fallot (HR 2.49).
Cohort (n=129)
Yes
Does severe preoperative tricuspid regurgitation predict adverse events in patients with repaired tetralogy of Fallot undergoing pulmonary valve replacement?
Severe preoperative tricuspid regurgitation is an independent predictor of adverse clinical events in patients with repaired tetralogy of Fallot undergoing pulmonary valve replacement, suggesting the need for close surveillance.
Hazard Ratio: 2.49 (95% CI 1.11–5.52)
p-value: p=0.028
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.
Bokma et al. (Tue,) conducted a cohort in Repaired tetralogy of Fallot (n=129). Severe preoperative tricuspid regurgitation vs. Non-severe tricuspid regurgitation was evaluated on Composite of adverse clinical events (death, sustained ventricular tachycardia, heart failure, or supraventricular tachycardia) (HR 2.49, 95% CI 1.11 to 5.52, p=0.028). Severe preoperative tricuspid regurgitation was independently predictive for adverse clinical events after pulmonary valve replacement in patients with repaired tetralogy of Fallot (HR 2.49).