Impact of right atrium dimension on adverse outcome after pulmonary valve replacement in repaired Tetralogy of Fallot pa
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ORIGINAL PAPER
Impact of right atrium dimension on adverse outcome after pulmonary valve replacement in repaired Tetralogy of Fallot patients Lamia Ait‑ALi1,2 · Chiara Marrone2 · Stefano Salvadori1 · Duccio Federici2 · Vitali Pak2 · Lugi Arcieri2 · Claudio Passino3 · Giuseppe Santoro2 · Pierluigi Festa2 Received: 10 March 2020 / Accepted: 18 May 2020 © Springer Nature B.V. 2020
Abstract The hemodynamic impact of residual pulmonary regurgitation (PR) in repaired Tetralogy of Fallot (rTOF) has been well demonstrated. However, markers driving the decision making process to indicate the ideal timing of pulmonary valve replacement (PVR) are still uncertain. Furthermore, very few studies have included the right atrium (RA) dilatation as a preoperative risk factor for post-PVR clinical adverse outcome. The aim of this study was to investigate the impact of pre-PVR right atrial dilation on adverse outcomes in rTOF. We retrospectively reviewed from our CMR database all rTOF patients who underwent CMR study before and after PVR. Detailed clinical and surgical history were collected, in addition to imaging data. The composite primary and secondary post-PVR end points were also recorded. The study cohort consisted of 41 patients (mean age at PVR repair 27.4 ± 10 years). As expected, end-diastolic and end-systolic right ventricle (RV) volumes significantly decreased after PVR (p 15 cm2/m2 [19]. Moreover, since 2011, right and left atrial volumes were also calculated from extended stack of SSFP acquisition [16] (Fig. 2). In a further analysis, we excluded patients who underwent surgical tricuspid plasty at the time of PVR to test the impact of the RA dimensions independently of severe tricuspid regurgitation or atrial surgical remodeling. In order to study RV remodeling, we calculated ΔRVESVi and ΔRVEDVi as the difference of RVESVi and RVEDVi pre and post PVR divided respectively by pre-PVR RVESVi and pre-PVR RVEDVi. Follow-up data were collected through patient visits in the out-patient clinic or reviewing the patient hospital records, if not available, by means of telephone interview. The composite primary end point included all causes of mortality, aborted sudden cardiac death or sustained ventricular tachycardia (VT). The composite secondary endpoint included worsening heart failure class (New York Heart Association III or IV), non-sustained VT or sustained supraventricular tachycardia (ectopic atrial tachycardia, atrial flutter or atrial fibrillation) [19]. The composite adverse outcome was defined as one of primary or secondary endpoint.
Statistical analysis Continuous variables were expressed as mean ± SD or median (25th; 75th percentiles) and categorical variables were expressed as frequency and percentage. The correlation between continuous variables was investigated by the Pearson’s correlation coefficient (r). The comparison between pre- and post- PVR repair for continuous variables was performed by paired samples t test. The comparison between patients with RA dilatation and the remaining population was explore
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