Long-term outcomes of adults with tricuspid regurgitation following transcatheter atrial septal defect closure

Background — Functional tricuspid regurgitation (TR) is a common pathophysiological condition in adults with 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.

Methods — We reviewed consecutive adult patients who underwent transcatheter ASD closure at Toronto General Hospital, Ontario, Canada, between 1998 and 2016. We linked our hospital registry with Ontario population-based health administrative databases to collect longitudinal data on inpatient and outpatient healthcare utilization and vital status.

Results — In this cohort study of 949 patients, 199 (22%) patients had moderate to severe TR prior to transcatheter ASD closure. A significant proportion of patients (61%) showed improvement in TR severity to at least mild TR following ASD intervention. At a median follow-up of 10.9 years, patients with baseline mild or no TR, compared to 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 hospitalization 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). Pre-procedural TR was independently associated with higher all-cause mortality (adjusted hazards ratio; HR=1.69, 95% confidence interval: 1.08-2.62).

Conclusions — TR 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.