LAUSR

A restrictive right ventricular (RV) physiology (r-RVP) is present in almost half of the patients with repaired tetralogy of Fallot (ToF), but its effect on later patients' clinical status is controversial. Evaluate the outcomes after transcatheter pulmonary valve implantation (TPVI) in patients with restrictive versus non-restrictive RV. Single-center retrospective study of patients who underwent TPVI for pulmonary regurgitation between 2008 and 2017. Electrocardiogram, transthoracic echocardiogram, cardiac magnetic resonance and cardio-pulmonary exercise test were performed previous to TPVI and repeated 12 months after. For statistical analysis restrictive physiology was defined as the presence of end-diastolic forward flow (EDFF) and RVEDVi <150ml/m2. Fifty-nine patients, 55 with tetralogy of Fallot, were included. R-RVP was present in 23 patients (39.0%). At the baseline, the majority of the patients were symptomatic, in NYHA functional class II–III (n=48, 81.4%) and with reduced cardiopulmonary performance (VO2max = 20.5mL/min/kg), both worse among patients with r-RVP (p=0.018 and p=0.018). During a mean follow-up of 446.4±226.1 days after TPVI one patient died. BNP levels were not significantly different from baseline. Despite self-reported functional capacity and exercise capacity improvement after TPVI (p<0.001), all parameters remained lower in r-RVP group. One year after TPVI, pulmonary and tricuspid regurgitation decrease significantly, as well as RVEDV, in both groups. However, RV systolic function remained unchanged in both groups. Regarding to the dysrhythmic profile, all patients with need for an implantable cardiac defibrillator and seven of the eight patients requiring radiofrequency ablation for sustained supraventricular arrhythmias during follow-up were in the group without r-RVP (p=0.038). Kaplan-Meier survival curve TPVI had a positive impact in clinical status in a cohort of patients with predominant PR regardless the presence of restrictive physiology. Moreover, besides higher VO2max and anaerobic threshold in the non-restrictive group, the magnitude of the improvement was not statistically different between the two groups. Nevertheless, in patients without r-RVP, a peculiar caution has to be focused regarding rhythmic issue during follow-up, despite the TPVI.