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Vol. 76. Issue 10.
Pages 774-782 (October 2023)
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Vol. 76. Issue 10.
Pages 774-782 (October 2023)
Original article
Outcome of moderate-severe tricuspid regurgitation after pulmonary endarterectomy or balloon pulmonary angioplasty
Evolución y pronóstico de la insuficiencia tricuspídea moderada-grave tras tromboendarterectomía pulmonar o angioplastia de arterias pulmonares
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Williams Hinojosaa,b,, Alejandro Cruz-Utrillaa,b,, Carmen Jiménez López-Guarcha,b,e, Maite Velázquez-Martína,b,e, Teresa Segura de la Cala,b, Lorena Gómez-Burgueñob, Macarena Oterob, María Jesús López-Gudea,c, Rafael Moralesa,d, José María Cortina-Romeroa,c, Jorge Solísb,e, Fernando Arribas Ynsurriagab,e, Pilar Escribano-Subíasa,b,e,
Corresponding author
a Unidad Multidisciplinar de Hipertensión Pulmonar, Hospital Universitario 12 de Octubre, Madrid, Spain
b Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
c Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Madrid, Spain
d Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, Spain
e Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Table 1. Clinical, echocardiographic, and hemodynamic characteristics of the study population stratified by the severity of postintervention tricuspid regurgitation
Table 2. Univariate and multivariate analysis of selected echocardiographic and hemodynamic predictors of the persistence of moderate-to-severe tricuspid regurgitation after pulmonary endarterectomy or balloon pulmonary angioplasty
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Abstract
Introduction and objectives

The management of persistent moderate-severe tricuspid regurgitation (TR) in patients with chronic thromboembolic pulmonary hypertension after treatment with pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty (BPA) is not well defined. This study aimed to analyze the progression and predictors of significant persistent postintervention TR and its prognostic impact.

Methods

This single-center observational study included 72 patients undergoing PEA and 20 who completed a BPA program with a previous diagnosis of chronic thromboembolic pulmonary hypertension and moderate-to-severe TR.

Results

The postintervention prevalence of moderate-to-severe TR was 29%, with no difference between the PEA- or BPA-treated groups (30.6% vs 25% P=.78). Compared with patients with absent-mild postprocedure TR, those with persistent TR had higher mean pulmonary arterial pressure (40.2±1.9 vs 28.5±1.3mmHg P <.001), pulmonary vascular resistance (472 [347-710] vs 282 [196-408] dyn.s/cm5; P <.001), and right atrial area (23.0 [21-31] vs 16.0 [14.0-20.0] P <.001). The variables independently associated with persistent TR were pulmonary vascular resistance> 400 dyn.s/cm5 and postprocedure right atrial area> 22cm2. No preintervention predictors were identified. The variables associated with increased 3-year mortality were residual TR and mean pulmonary arterial pressure> 30mmHg.

Conclusions

Residual moderate-to-severe TR following PEA-PBA was associated with persistently high afterload and unfavorable postintervention right chamber remodeling. Moderate-to-severe TR and residual pulmonary hypertension were associated with a worse 3-year prognosis.

Keywords:
Pulmonary hypertension
Tricuspid regurgitation
Balloon angioplasty
Endarterectomy
Abbreviations:
BPA
CTEPH
PEA
PH
RV
TR
Resumen
Introducción y objetivos

No está definido el abordaje de la insuficiencia tricuspídea (IT) funcional moderada-grave en los pacientes con hipertensión pulmonar tromboembólica crónica tras la tromboendarterectomía pulmonar (TEA) o angioplastia con balón de las arterias pulmonares (ABAP). El objetivo de este estudio es analizar la evolución y los predictores de IT residual tras el procedimiento, así como su impacto pronóstico.

Métodos

Estudio observacional unicéntrico. Se incluyó a 72 pacientes sometidos a TEA y 20 que completaron el programa de ABAP con diagnóstico de hipertensión pulmonar tromboembólica crónica y presentaban IT moderada-grave antes del procedimiento intervencionista.

Resultados

La prevalencia de IT moderada-grave tras el procedimiento fue del 29%, sin diferencias entre los tratados con TEA o ABAP (el 30,6 frente al 25%; p=0,78). En el grupo con IT persistente se hallaron mayores presión arterial pulmonar media (40,2± 1,9 frente a 28,5±1,3mmHg; p<0,001), resistencia vascular pulmonar (472 [347-710] frente a 282 [196-408] dyn·s/cm5; p <0,001) y área de la aurícula derecha (23,0 [21-31] frente a 16,0 [14,0-20,0]; p <0,001) tras el procedimiento comparado con el de pacientes con IT ausente-ligera. La resistencia vascular pulmonar> 400dyn.s/cm5 y el área de la aurícula derecha> 22 cm2 tras el procedimiento se asociaron de manera independiente con la persistencia de la IT, pero no se identificaron predictores antes de la intervención. La IT moderada-grave residual y la presión pulmonar media> 30mmHg se asociaron con mayor mortalidad en 3 años de seguimiento.

Conclusiones

La IT moderada-grave residual posterior a TEA o ABAP se asoció con la persistencia de una mayor poscarga y un persistente remodelado desfavorable de las cámaras cardiacas derechas tras el procedimiento. La IT moderada-grave y la hipertensión pulmonar residual se asociaron con un peor pronóstico a 3 años.

Palabras clave:
Hipertensión pulmonar
Insuficiencia tricuspídea
Angioplastia con balón
Tromboendarterectomía

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