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.

bsSec_2">Objectives

bspara0015">This study sought to assess the prevalence of and factors associated with significant TR in patients undergoing TPVR for RVOT obstruction or PR.

bsSec_3">Methods

bspara0020">Data were combined from 3 prospective multicenter trials of patients referred for TPVR. Follow-up data through 5 years post-implantation were analyzed.

bsSec_4">Results

bspara0025">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.

bsSec_5">Conclusions

bspara0030">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.