Comparison of outcomes between transcatheter versus surgical closure of atrial septal defect in patients with significant tricuspid regurgitation

Abstract

Background: The volume overload of right ventricle due to left to right shunt in atrial septal defect (ASD) patients causes functional tricuspid regurgitation (TR). Transcatheter ASD closure using device has been established as an effective treatment. However, clinical outcomes of patients with ASD and significant TR after this procedure has not been elucidated as compared with surgical treatment. Methods: A total of 252 consecutive adult patients who showed a significant (moderate or more) TR before ASD closure were retrospectively enrolled. ASD device closure or surgical tricuspid annuloplasty (TAP) along with ASD closure were performed in 68 and 184 patients, respectively. The severity of TR and clinical events were followed up. The primary endpoint was a composite of any cause of death, stroke, and heart failure. The secondary endpoint was a remnant significant TR at 1 year after ASD closure. Results: A significant TR remained in 81 (32%) out of 252 patients in immediately after ASD closure and in 52 (29%) out of 182 patients after 1 year. The severity of TR was significantly decreased after transcatheter ASD closure. In multivariable analysis, TAP and ASD diameter were independent predictors of the remnant significant TR immediately after treatment, while only TAP was the predictor after 1 year follow-up. After propensity score matching between two groups, there was no significant difference between the two groups in primary composite clinical outcomes during a median follow-up of 3.4 years. Conclusions: TAP is effective for the treatment of significant TR, but transcatheter ASD closure also reduces TR. Transcatheter ASD closure showed comparable clinical outcomes to surgical closure and TAP in patients with moderate and severe TR, and therefore can be a reasonable treatment option.