Transcatheter Pulmonary Valve Replacement Reduces Tricuspid Regurgitation in Patients With Right Ventricular Volume/Pressure Overload

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• 作者：Thomas K. Jones ; MD^a ; Jonathan J. Rome ; MD^b ; Aimee K. Armstrong ; MD^c ; Felix Berger ; MD^d ; William E. Hellenbrand ; MD^e ; Allison K. Cabalka ; MD^f ; Lee N. Benson ; MD^g ; David T. Balzer ; MD^h ; John P. Cheatham ; MD^c ; Andreas Eicken ; MDⁱ ; Doff B. McElhinney ; MD^j ; ^{doffmcelhinney@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：catheterization ; cohort studies ; congenital ; heart defects ; percutaneous valve ; prospective studies ; tetralogy of Fallot
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：4 October 2016
• 年：2016
• 卷：68
• 期：14
• 页码：1525-1535
• 全文大小：869 K

文摘

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.

Objectives

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

Methods

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

Results

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.

Conclusions

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.