Author + information
- Received September 20, 2016
- Revision received January 19, 2017
- Accepted January 27, 2017
- Published online April 3, 2017.
- Daniel Tanase, MDa,∗ (, )
- Peter Ewert, MD, PhDa,
- Stanimir Georgiev, MDa,
- Christian Meierhofer, MDa,
- Jelena Pabst von Ohain, MD, PhDb,
- Doff B. McElhinney, MDc,
- Alfred Hager, MD, PhDa,
- Andreas Kühn, MDa and
- Andreas Eicken, MD, PhDa
- aDepartment of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre of the Technical University Munich, Munich, Germany
- bDepartment of Cardiovascular Surgery, German Heart Centre of the Technical University Munich, Munich, Germany
- cLucille Packard Children’s Hospital Stanford, Palo Alto, California
- ↵∗Address for correspondence:
Dr. Daniel Tanase, German Heart Centre of the Technical University Munich, Department of Paediatric Cardiology and Congenital Heart Defects, Lazarettstrasse 36, D-80636 Munich, Germany.
Objectives This study sought to investigate the impact of tricuspid regurgitation (TR) on right ventricular function after percutaneous pulmonary valve implantation (PPVI).
Background PPVI provides a less invasive alternative to surgery in patients with right ventricular-to-pulmonary artery (RV-PA) conduit dysfunction. Recovery of the right ventricle has been described after PPVI for patients with pulmonary stenosis and for those with pulmonary regurgitation. Additional TR enforces RV dysfunction by supplemental volume overload. Limited data are available on the potential of the right ventricle to recover in such a specific hemodynamic situation.
Methods In a matched cohort study, we compared patients who underwent PPVI with additional TR with those without TR.
Results The degree of TR improved in 83% of the patients. In our patients (n = 36) exercise capacity and right ventricular volume index improved similarly 6 months after PPVI in patients with and without important TR. None of them had significant TR in the long-term follow-up of median 78 months.
Conclusions PPVI improves not only RV-PA-conduit dysfunction, but also concomitant TR. In patients with a dysfunctional RV-PA conduit and TR, the decision whether to fix TR should be postponed after PPVI.
Dr. Ewert has received personal fees (proctor) for the Medtronic Melody valve; and is a proctor for Edwards pulmonic transcatheter valve. Dr. McElhinney is proctor and consultant for Medtronic. Dr. Hager has received speakers honoraria from AbbottVirology Encysive GmbH, Pfizer, Actelion, Abbott, Medtronic, Schiller Medizintechnik GmbH, GlaxoSmithKline, AOP, Orphan Pharmaceuticals AG, and OMT; honoraria for writing informational material from Actelion; travel compensations from Braun, Guidant, Arrows, Medtronic, Actelion, GlaxoSmithKline, Pfizer, Lilly, AOP, and Orphan Pharmaceuticals AG; is a shareholder of Johnson & Johnson, Gilead, Merck Sharp & Dohme Inc., Pfizer, Medtronic, and Roche; his institution contributed to company-driven clinical trials from Actelion, Medtronic, Edwards, Occlutec, Novartis, and Lilly; and his institution received unrestricted scientific grants for investigator initiated trials from Pfizer, GlaxoSmithKline, Abbott, Actelion, and Medtronic. Dr. Eicken is a proctor for the Medtronic Melody valve. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 20, 2016.
- Revision received January 19, 2017.
- Accepted January 27, 2017.
- 2017 American College of Cardiology Foundation