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Original article
Severe tricuspid regurgitation is predictive for adverse events in tetralogy of Fallot
  1. Jouke P Bokma1,2,
  2. Michiel M Winter1,
  3. Thomas Oosterhof1,
  4. Hubert W Vliegen3,
  5. Arie P van Dijk4,
  6. Mark G Hazekamp5,6,
  7. Dave R Koolbergen5,6,
  8. Maarten Groenink1,
  9. Barbara J M Mulder1,2,
  10. Berto J Bouma1,2
  1. 1Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
  2. 2Interuniversity Cardiology Institute of the Netherlands
  3. 3Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  4. 4Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
  5. 5Department of Cardiothoracic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
  6. 6Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Dr B J Bouma, Department of Cardiology, Academic Medical Center Amsterdam, room B2-256, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; b.j.bouma{at}amc.uva.nl

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/m2, 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/m2 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.

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