Surgical management of transvenous lead-induced tricuspid regurgitation in adult and pediatric patients with congenital heart disease
Ying Huang, Joseph A. Dearani, Brian D. Lahr, Elizabeth H. Stephens, Malini Madhavan, Bryan C. Cannon, Hartzell V. Schaff
Objective: The objective of this study was to evaluate outcomes of surgical management of lead-induced tricuspid regurgitation (TR) in patients with congenital heart disease. Methods: We analyzed data of 54 consecutive patients who underwent tricuspid valve (TV) surgery from 1998 to 2015 for lead-induced TR. Primary end points, including mortality, TV reinterventions, and longitudinal TR measurements, were analyzed with the Kaplan–Meier method or with repeated measures proportional odds modeling. Results: The median age of patients was 48.2 years (interquartile range, 37.3-59.0 years); 31 (57.4%) were female; 2 (3.7%) were children. Thirty patients (55.6%) underwent TV repair and 24 (44.4%) had replacement, and 52 underwent concomitant cardiac procedures. Thirty-day mortality was 1.9% (repair: 3.3%, replacement: 0.0%). Five-year survival was 80.4% overall and 79.7% and 81.4% for the repair and replacement groups, respectively. In response to surgery, TR improved in both groups (each P < .001) but more with replacement than repair (P < .001); longitudinal analysis showed that TR trends observed early on favoring replacement were sustained across follow-up (P < .001). The model-estimated risk of moderate or severe TR at 5-year follow-up, conditional on having severe preoperative TR, was 74.4% for the repair and 10.7% for the replacement group. Five-year cumulative risk of TV reintervention was comparable for valve repair and replacement. Conclusions: Despite the need for concomitant cardiac procedures in most of the patients, early mortality was low after TV surgery. Survival and rate of TV reintervention were comparable for the repair and replacement groups. However, TV repair was associated with progressive TR during intermediate follow-up, especially in patients with severe preoperative TR.
2185-2193.e4
Journal of Thoracic and Cardiovascular Surgery
https://doi.org/10.1016/j.jtcvs.2021.10.006
reintervention
transvenous lead
tricuspid regurgitation
tricuspid valve surgery
Pulmonary and Respiratory Medicine
10.1016/j.jtcvs.2021.10.006
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Tricuspid Valve Insufficiency Medicine & Life Sciences 100%
Tricuspid Valve Medicine & Life Sciences 73%
Pediatrics Medicine & Life Sciences 51%
Survival Rate Medicine & Life Sciences 6%
Survival Medicine & Life Sciences 4%
Huang, Y., Dearani, J. A., Lahr, B. D., Stephens, E. H., Madhavan, M., Cannon, B. C., & Schaff, H. V. (2022). Surgical management of transvenous lead-induced tricuspid regurgitation in adult and pediatric patients with congenital heart disease. Journal of Thoracic and Cardiovascular Surgery, 163(6), 2185-2193.e4. https://doi.org/10.1016/j.jtcvs.2021.10.006
Surgical management of transvenous lead-induced tricuspid regurgitation in adult and pediatric patients with congenital heart disease. / Huang, Ying; Dearani, Joseph A.; Lahr, Brian D. et al.
In: Journal of Thoracic and Cardiovascular Surgery, Vol. 163, No. 6, 06.2022, p. 2185-2193.e4.
Huang, Y, Dearani, JA, Lahr, BD, Stephens, EH, Madhavan, M, Cannon, BC & Schaff, HV 2022, 'Surgical management of transvenous lead-induced tricuspid regurgitation in adult and pediatric patients with congenital heart disease', Journal of Thoracic and Cardiovascular Surgery, vol. 163, no. 6, pp. 2185-2193.e4. https://doi.org/10.1016/j.jtcvs.2021.10.006
Huang Y, Dearani JA, Lahr BD, Stephens EH, Madhavan M, Cannon BC et al. Surgical management of transvenous lead-induced tricuspid regurgitation in adult and pediatric patients with congenital heart disease. Journal of Thoracic and Cardiovascular Surgery. 2022 Jun;163(6):2185-2193.e4. doi: 10.1016/j.jtcvs.2021.10.006
Huang, Ying ; Dearani, Joseph A. ; Lahr, Brian D. et al. / Surgical management of transvenous lead-induced tricuspid regurgitation in adult and pediatric patients with congenital heart disease. In: Journal of Thoracic and Cardiovascular Surgery. 2022 ; Vol. 163, No. 6. pp. 2185-2193.e4.
@article{863f70078ce6475083f754bbe7a1ba80,
title = "Surgical management of transvenous lead-induced tricuspid regurgitation in adult and pediatric patients with congenital heart disease",
abstract = "Objective: The objective of this study was to evaluate outcomes of surgical management of lead-induced tricuspid regurgitation (TR) in patients with congenital heart disease. Methods: We analyzed data of 54 consecutive patients who underwent tricuspid valve (TV) surgery from 1998 to 2015 for lead-induced TR. Primary end points, including mortality, TV reinterventions, and longitudinal TR measurements, were analyzed with the Kaplan–Meier method or with repeated measures proportional odds modeling. Results: The median age of patients was 48.2 years (interquartile range, 37.3-59.0 years); 31 (57.4%) were female; 2 (3.7%) were children. Thirty patients (55.6%) underwent TV repair and 24 (44.4%) had replacement, and 52 underwent concomitant cardiac procedures. Thirty-day mortality was 1.9% (repair: 3.3%, replacement: 0.0%). Five-year survival was 80.4% overall and 79.7% and 81.4% for the repair and replacement groups, respectively. In response to surgery, TR improved in both groups (each P < .001) but more with replacement than repair (P < .001); longitudinal analysis showed that TR trends observed early on favoring replacement were sustained across follow-up (P < .001). The model-estimated risk of moderate or severe TR at 5-year follow-up, conditional on having severe preoperative TR, was 74.4% for the repair and 10.7% for the replacement group. Five-year cumulative risk of TV reintervention was comparable for valve repair and replacement. Conclusions: Despite the need for concomitant cardiac procedures in most of the patients, early mortality was low after TV surgery. Survival and rate of TV reintervention were comparable for the repair and replacement groups. However, TV repair was associated with progressive TR during intermediate follow-up, especially in patients with severe preoperative TR.",
keywords = "congenital heart disease, reintervention, survival, transvenous lead, tricuspid regurgitation, tricuspid valve surgery",
author = "Ying Huang and Dearani, {Joseph A.} and Lahr, {Brian D.} and Stephens, {Elizabeth H.} and Malini Madhavan and Cannon, {Bryan C.} and Schaff, {Hartzell V.}",
note = "Funding Information: This study was supported by Dr Dearani{\textquoteright}s Sheikh Zayed Professorship of Cardiovascular Diseases Honoring George M. Gura, MD. Publisher Copyright: {\textcopyright} 2021 The American Association for Thoracic Surgery",
doi = "10.1016/j.jtcvs.2021.10.006",
pages = "2185--2193.e4",
journal = "Journal of Thoracic and Cardiovascular Surgery",
T1 - Surgical management of transvenous lead-induced tricuspid regurgitation in adult and pediatric patients with congenital heart disease
AU - Huang, Ying
AU - Dearani, Joseph A.
AU - Lahr, Brian D.
AU - Stephens, Elizabeth H.
AU - Madhavan, Malini
AU - Cannon, Bryan C.
AU - Schaff, Hartzell V.
N1 - Funding Information: This study was supported by Dr Dearani's Sheikh Zayed Professorship of Cardiovascular Diseases Honoring George M. Gura, MD. Publisher Copyright: © 2021 The American Association for Thoracic Surgery
N2 - Objective: The objective of this study was to evaluate outcomes of surgical management of lead-induced tricuspid regurgitation (TR) in patients with congenital heart disease. Methods: We analyzed data of 54 consecutive patients who underwent tricuspid valve (TV) surgery from 1998 to 2015 for lead-induced TR. Primary end points, including mortality, TV reinterventions, and longitudinal TR measurements, were analyzed with the Kaplan–Meier method or with repeated measures proportional odds modeling. Results: The median age of patients was 48.2 years (interquartile range, 37.3-59.0 years); 31 (57.4%) were female; 2 (3.7%) were children. Thirty patients (55.6%) underwent TV repair and 24 (44.4%) had replacement, and 52 underwent concomitant cardiac procedures. Thirty-day mortality was 1.9% (repair: 3.3%, replacement: 0.0%). Five-year survival was 80.4% overall and 79.7% and 81.4% for the repair and replacement groups, respectively. In response to surgery, TR improved in both groups (each P < .001) but more with replacement than repair (P < .001); longitudinal analysis showed that TR trends observed early on favoring replacement were sustained across follow-up (P < .001). The model-estimated risk of moderate or severe TR at 5-year follow-up, conditional on having severe preoperative TR, was 74.4% for the repair and 10.7% for the replacement group. Five-year cumulative risk of TV reintervention was comparable for valve repair and replacement. Conclusions: Despite the need for concomitant cardiac procedures in most of the patients, early mortality was low after TV surgery. Survival and rate of TV reintervention were comparable for the repair and replacement groups. However, TV repair was associated with progressive TR during intermediate follow-up, especially in patients with severe preoperative TR.
AB - Objective: The objective of this study was to evaluate outcomes of surgical management of lead-induced tricuspid regurgitation (TR) in patients with congenital heart disease. Methods: We analyzed data of 54 consecutive patients who underwent tricuspid valve (TV) surgery from 1998 to 2015 for lead-induced TR. Primary end points, including mortality, TV reinterventions, and longitudinal TR measurements, were analyzed with the Kaplan–Meier method or with repeated measures proportional odds modeling. Results: The median age of patients was 48.2 years (interquartile range, 37.3-59.0 years); 31 (57.4%) were female; 2 (3.7%) were children. Thirty patients (55.6%) underwent TV repair and 24 (44.4%) had replacement, and 52 underwent concomitant cardiac procedures. Thirty-day mortality was 1.9% (repair: 3.3%, replacement: 0.0%). Five-year survival was 80.4% overall and 79.7% and 81.4% for the repair and replacement groups, respectively. In response to surgery, TR improved in both groups (each P < .001) but more with replacement than repair (P < .001); longitudinal analysis showed that TR trends observed early on favoring replacement were sustained across follow-up (P < .001). The model-estimated risk of moderate or severe TR at 5-year follow-up, conditional on having severe preoperative TR, was 74.4% for the repair and 10.7% for the replacement group. Five-year cumulative risk of TV reintervention was comparable for valve repair and replacement. Conclusions: Despite the need for concomitant cardiac procedures in most of the patients, early mortality was low after TV surgery. Survival and rate of TV reintervention were comparable for the repair and replacement groups. However, TV repair was associated with progressive TR during intermediate follow-up, especially in patients with severe preoperative TR.
KW - congenital heart disease
KW - reintervention
KW - survival
KW - transvenous lead
KW - tricuspid regurgitation
KW - tricuspid valve surgery
U2 - 10.1016/j.jtcvs.2021.10.006
DO - 10.1016/j.jtcvs.2021.10.006
SP - 2185-2193.e4
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery