PMID- 25828460
OWN - NLM
STAT- MEDLINE
DCOM- 20150629
LR  - 20150427
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 101
IP  - 10
DP  - 2015 May 15
TI  - Severe tricuspid regurgitation is predictive for adverse events in tetralogy of 
      Fallot.
PG  - 794-9
LID - 10.1136/heartjnl-2014-306919 [doi]
AB  - 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.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not 
      already granted under a licence) please go to 
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Bokma, Jouke P
AU  - Bokma JP
AD  - Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, The 
      Netherlands Interuniversity Cardiology Institute of the Netherlands.
FAU - Winter, Michiel M
AU  - Winter MM
AD  - Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, The 
      Netherlands.
FAU - Oosterhof, Thomas
AU  - Oosterhof T
AD  - Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, The 
      Netherlands.
FAU - Vliegen, Hubert W
AU  - Vliegen HW
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, The 
      Netherlands.
FAU - van Dijk, Arie P
AU  - van Dijk AP
AD  - Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, 
      The Netherlands.
FAU - Hazekamp, Mark G
AU  - Hazekamp MG
AD  - Department of Cardiothoracic Surgery, Academic Medical Center Amsterdam, 
      Amsterdam, The Netherlands Department of Cardiothoracic Surgery, Leiden 
      University Medical Center, Leiden, The Netherlands.
FAU - Koolbergen, Dave R
AU  - Koolbergen DR
AD  - Department of Cardiothoracic Surgery, Academic Medical Center Amsterdam, 
      Amsterdam, The Netherlands Department of Cardiothoracic Surgery, Leiden 
      University Medical Center, Leiden, The Netherlands.
FAU - Groenink, Maarten
AU  - Groenink M
AD  - Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, The 
      Netherlands.
FAU - Mulder, Barbara J M
AU  - Mulder BJ
AD  - Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, The 
      Netherlands Interuniversity Cardiology Institute of the Netherlands.
FAU - Bouma, Berto J
AU  - Bouma BJ
AD  - Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, The 
      Netherlands Interuniversity Cardiology Institute of the Netherlands.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20150331
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
SB  - IM
MH  - Adult
MH  - Cardiac Surgical Procedures/*adverse effects
MH  - Female
MH  - Heart Valve Prosthesis Implantation/*adverse effects
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Linear Models
MH  - Male
MH  - Multivariate Analysis
MH  - Netherlands
MH  - Proportional Hazards Models
MH  - Pulmonary Valve/physiopathology/surgery
MH  - Pulmonary Valve Insufficiency/etiology/physiopathology/*surgery
MH  - Pulmonary Valve Stenosis/etiology/physiopathology/*surgery
MH  - Reoperation
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Tetralogy of Fallot/diagnosis/physiopathology/*surgery
MH  - Treatment Outcome
MH  - Tricuspid Valve Insufficiency/diagnosis/*etiology/physiopathology/surgery
MH  - Young Adult
EDAT- 2015/04/02 06:00
MHDA- 2015/06/30 06:00
CRDT- 2015/04/02 06:00
PHST- 2014/10/08 00:00 [received]
PHST- 2015/03/11 00:00 [accepted]
PHST- 2015/04/02 06:00 [entrez]
PHST- 2015/04/02 06:00 [pubmed]
PHST- 2015/06/30 06:00 [medline]
AID - heartjnl-2014-306919 [pii]
AID - 10.1136/heartjnl-2014-306919 [doi]
PST - ppublish
SO  - Heart. 2015 May 15;101(10):794-9. doi: 10.1136/heartjnl-2014-306919. Epub 2015 
      Mar 31.