Long-term Outcomes of Adults With Tricuspid Regurgitation Following Transcatheter Atrial Septal Defect Closure |
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| Institution: | 1. Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada;2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;3. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada;4. ICES, Toronto, Ontario, Canada;5. Institute of Medical Science, Cardiovascular Sciences Collaborative Program University of Toronto, Toronto, Ontario, Canada;6. Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada;7. Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada;8. Division of Cardiology, University of Toronto School of Medicine, Toronto, Ontario, Canada;1. Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada;2. Geneva University Hospitals, Geneva, Switzerland;1. Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada;2. Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland;1. Cardiology, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy;2. Cardiac Surgery, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy;3. Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy;4. Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy;1. Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada;2. Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada;3. Department of Pathology, University of Health Network, University of Toronto, Toronto, Ontario, Canada |
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| Abstract: | BackgroundFunctional tricuspid regurgitation (TR) is a common pathophysiologic condition in adults with ostium secundum atrial septal defect (ASD). The aim of this study was to evaluate long-term outcomes following transcatheter ASD closure, which have not been well studied among patients with significant TR.MethodsWe reviewed consecutive adult patients who underwent transcatheter ASD closure at Toronto General Hospital, Ontario, Canada, from 1998 to 2016. We linked our hospital registry with Ontario population-based health administrative databases to collect longitudinal data on inpatient and outpatient health care utilisation and vital status.ResultsIn this cohort study of 949 patients, 199 (22%) had moderate to severe TR before transcatheter ASD closure. A significant proportion of patients (61%) showed improvement in TR severity to at least mild TR after ASD intervention. At a median follow-up of 10.9 years, patients with baseline mild or no TR, compared with those with greater than moderate TR, had significantly lower rates of all-cause mortality (6.8 vs 22.5 per 1000 person-years PY]; P < 0.001), composite hospitalisation for atrial fibrillation (AF) or heart failure (HF) (22.3 vs 49.1 per 1000 PY; P < 0.001), and new onset of AF (10.4 vs 20.2 per 1000 PY; P = 0.002) and HF (5.0 vs 9.2 per 1000 PY; P = 0.039). Preprocedural TR was independently associated with higher all-cause mortality (adjusted hazard ratio 1.69, 95% confidence interval 1.08-2.62).ConclusionsTR severity was independently associated with a higher risk of mortality and morbidity. Further investigation of earlier device closure or concomitant tricuspid valve intervention may be of interest. |
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