Profesionales médicos

Overview

Juan A. Crestanello, M.D., is a cardiovascular surgeon and department chair of Cardiovascular Surgery at Mayo Clinic in Rochester, Minnesota. Dr. Crestanello, who specializes in surgery for valvular heart disease, discusses surgical management of transvenous lead-induced tricuspid regurgitation in adult and pediatric patients with congenital heart disease.

JUAN CASTANELLO: Welcome to the Cardiovascular Surgery Series where I review the latest research in cardiovascular surgery from the Mayo Clinic in just two minutes. I will review today the article entitled "Surgical management of transvenous lead-induced tricuspid regurgitation in adult and pediatric patients with congenital heart disease."

There is an increase in the use of permanent pacemakers and ICDs on patients with congenital heart disease. Lead-induced tricuspid regurgitation is a serious complication of transvenous cardiac leads.

Among 1,400 patients with congenital heart disease who had tricuspid valve surgery at our institution, TR was induced by placing leads in 54 patients. Tricuspid valve repair was performed in 56% of the patients and replacements in 44%.

Most patients require concomitant procedures. In spite of that, the operative mortality was only 1.9%. Tricuspid regurgitation improved in both groups after surgery. In the immediate post-op period, the percentage of patients with moderate or severe TR decreased from 96% to 27% among patients who had valve repair and from 100% to 0% among those who had valve replacement.

The probability of moderate or severe TR in follow-up was higher with tricuspid valve repair than with replacement. The long-term survival, however, was similar, and the rate of reintervention in the tricuspid valve for repair or replacement was also similar.

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