P3655Right ventricular volume off-loading following atrial septal defect closure or pulmonary valve replacement: impact on tricuspid regurgitation and mid-term remodeling

Abstract

Abstract Introduction Cardiac surgery or catheter intervention is nowadays commonly performed to abolish volume loading of the right ventricle (RV) in adults with congenital heart disease (ACHD). Purpose Little is known, however, of their impact on the preexisting tricuspid regurgitation (TR) following such procedures (atrial septal defect [ASD] closure and pulmonary valve replacement [PVR]), which was the aim of our study. Methods Demographics, clinical and echocardiographic characteristics were analyzed from 162 consecutive patients undergoing such interventions between July 2005 and December 2014, who had at least mild preoperative TR. Results Mean age at intervention was 42±16 years (38.3% male); 101 patients underwent ASD closure, whereas 61 patients PVR. Only 11.1% receiving concomitant tricuspid valve surgery (repair). There was significant overall improvement in severity of TR, from 38 (23.5%) patients having moderate or severe TR preoperatively to only 11 (6.8%) and 20 (12.3%) at 6 and 12 months of follow-up, respectively (p<0.05) (Figure 1) (Table 1). Improvement in TR was observed in patients who did not have concomitant TV repair, from 15.3% to 6.9% and 11,8%, 6 and 12 months, respectively (p<0.05). Echocardiographic data Echo 1 (baseline) Echo 2 (6 months) Echo 3 (12 months) p-value† ‡Echo 1 ‡Echo 2 ‡Echo 3 TR grade (none = 1, mild = 2, moderate = 3, severe = 4) 2.3±0.6 1.6±0.6 1.7±0.8 <0.0001 A B B End-diastolic tricuspid annulus diameter (cm) 4.3±0.6 3.6±0.6 3.5±0.5 <0.0001 A B B Systolic tenting area (cm2) 0.7±0.5 0.5±0.2 0.5±0.3 <0.0001 A B B Coaptation distance (cm) 0.6±0.2 0.4±0.2 0.4±0.2 <0.0001 A B B End-diastolic area (cm2) 30.3±7.5 21.7±6.0 20.6±6.0 <0.0001 A B C Fractional area change (%) 39.4±8.4 39.0±8.0 39.9±8.1 0.58 A A A RV mid diameter (cm) 4.2±0.7 3.3±0.7 3.2±0.6 <0.0001 A B B RVOT end-diastolic proximal diameter (cm) 4.4±0.6 3.8±0.6 3.6±0.5 <0.0001 A B C TAPSE (cm) 2.1±0.6 1.4±0.5 1.4±0.4 <0.0001 A B B Lateral TDi S (cm/s) 12.4±3.3 8.8±3.0 9.2±3.0 <0.0001 A B B Systolic pulmonary artery pressure (mmHg) 42.4±13.4 34.8±10.1 35.1±11.6 <0.0001 A B B LVEF (normal = 1, mild LV dysfunction = 2, moderate = 3, severe = 4) 1.0±0.2 1.0±0.2 1.0±0.2 0.80 A A A RA area (cm2) 26.1±9.6 19.5±6.6 19.2±6.7 <0.0001 A B B *One-way ANOVA comparison. ‡Tukey pairwise comparison between Echos 1, 2 and 3: means that do not share a letter are significantly different (i.e. p<0.05). Figure 1 Conclusions ASD closure or PVR are commonly associated with significant reduction of preoperative functional tricuspid regurgitation event amongst patients who did not undergo concomitant tricuspid valve surgery.