Prevalence and impact of preoperative moderate/severe tricuspid regurgitation on patients undergoing transcatheter aortic valve replacement

Abstract

In patients undergoing TAVR, significant preoperative TR was present in 15% of patients and associated with more comorbidities. Despite being associated with a doubling of mortality rate, after a robust adjustment, significant TR was not an independent predictor of 2-year mortality. However, a significant interaction between TR and left ventricular systolic function was found. The response of TR to TAVR was extremely variable.

Contemporary Trends in the Use and Outcomes of Surgical Treatment of Tricuspid Regurgitation

“…Most patients experiencing significant TR have concomitant valvular disease. Moderate‐to‐severe TR is present in 30% to 50% of patients with severe mitral regurgitation and in 12% to 25% of patients with severe aortic stenosis 4, 24, 25, 26, 27, 28. TR has been shown to be an independent negative predictor of long‐term survival among the following: (1) patients with multivalvular disease undergoing surgical or transcatheter aortic and mitral valve treatment,1, 2, 4, 25 (2) patients with heart failure who are treated medically,24, 29 and (3) patients with severe isolated TR who are treated medically 30, 31.…”

Effect of Right Ventricular Function and Tricuspid Regurgitation on Outcomes After Transcatheter Aortic Valve Implantation

“…In this particular hemodynamic situation, TR is only a bystander and the clinical outcome is directly related to relevant MR. In this context, it is important to note that the prevalence of MR was rather high (40.1%) in the study by Barbanti et al, 7 which may explain at least in part the lack of effect of TR after multivariable adjustment.…”

“…However, TR severity was not associated with mortality after multivariable adjustments in these studies. 7,15 Although conflicting with the results of Lindman et al, 11 these findings challenge the widespread notion that successful treatment of left-sided valve disease effectively resolves secondary manifestations, including TR. Thus, improvement of TR requires not only reversal of its primary underlying cause, such as pulmonary hypertension, MR, or left ventricular dysfunction, but also normalization of the tricuspid annular abnormalities.…”

“…6 Despite limited data, relevant tricuspid regurgitation (TR) seems equally frequent, affecting 15% to 25% of patients undergoing TAVI. 7,8 In the past, both MR and TR have been associated with an increased risk of mortality after SAVR. 9,10 More recently, moderate to severe MR has also been related to worse clinical outcomes after TAVI, 6 whereas the association is less well established among patients with relevant TR.…”

“…9,10 More recently, moderate to severe MR has also been related to worse clinical outcomes after TAVI, 6 whereas the association is less well established among patients with relevant TR. 7 Although the prognostic effect of left-sided heart disease has been well investigated, far less attention has been paid to the right side of the heart, in particular, right ventricular (RV) function and tricuspid valve regurgitation. The study published in this issue of Circulation: Cardiovascular Interventions by Lindman et al 11 intends to fill this gap in our knowledge.…”