BASELINE SIGNIFICANT TRICUSPID REGURGITATION INCREASES RISK OF MORTALITY IN POST TRANSCATHETER AORTIC VALVE REPLACEMENT: SYSTEMIC REVIEW AND META-ANALYSIS OF MULTIVARIABLE ADJUSTED OBSERVATIONAL STUDIES

Background and Objetives: According to the guidelines a concomitant tricuspid annuloplasty should be performed at the time of mitral or aortic valve surgery in presence of: i) severe tricuspid regurgitation (TR) or ii) mild-to-moderate TR with significant tricuspid annulus dilation (TAD, i.e. diameter>40 mm by echo). In patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), no tricuspid annuloplasty or replacement is performed. The objective of this study was to determine the prevalence of TR and TAD and their impact on mortality following TAVR. Methods: TR and TAD were assessed by transthoracic echocardiography in 227 consecutive patients who underwent TAVR at our institution. The primary end-point was all-cause mortality. Results: Figure 1 shows the distribution of the patients according to TR severity and presence of TAD. Overall, very few patients had none or trace TR, 88% had mild or moderate TR, and 7% had severe TR. Furthermore, 73% had TAD. After a mean follow-up of 1.5± 1.2 years, 73 patients died. Two-year survival rate was 52±8% in patients with severe TR, 65±5% in patients with mild/moderate TR and TAD, and 87± 7% in patients with mild/moderate TR and no significant TAD (Figure 2). After adjustment for sex, EuroSCORE, creatinine and other risk factors, mild/moderate TR with TAD had higher risk of mortality (HR : 2.88; 95% CI :1.3-8.9; p=0.025) compared to mild/moderate TR without TAD and similar risk (HR : 1.34; 95% CI :0.6-3.7; p=0.53) compared to severe TR Conclusion: Both TR and TAD are highly prevalent in the patients with severe AS undergoing TAVR. Among patients with mild/moderate TR, those with significant TAD have worse outcomes compared to those with no TAD and similar outcomes compared to those with severe TR. Further studies are needed to determine if concomitant or subsequent transcatheter tricuspid annuloplasty or replacement would improve outcomes of patients undergoing TAVR.

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Delirium is associated with higher mortality in transcatheter aortic valve replacement: systemic review and meta-analysis

Cardiovascular Intervention and Therapeutics ◽

10.1007/s12928-019-00592-y ◽

2019 ◽

Vol 35 (2) ◽

pp. 168-176 ◽

Cited By ~ 2

Author(s):

Narut Prasitlumkum ◽

Raktham Mekritthikrai ◽

Jakrin Kewcharoen ◽

Chanavuth Kanitsoraphan ◽

Michael A. Mao ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Meta Analysis ◽

Systemic Review ◽

Transcatheter Aortic Valve

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Single or dual antiplatelet therapy after transcatheter aortic valve replacement: an updated systemic review and meta-analysis

Journal of Thoracic Disease ◽

10.21037/jtd.2019.01.87 ◽

2019 ◽

Vol 11 (3) ◽

pp. 959-968 ◽

Cited By ~ 6

Author(s):

Wenjie Zuo ◽

Mingming Yang ◽

Yanru He ◽

Chunshu Hao ◽

Lijuan Chen ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Antiplatelet Therapy ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Dual Antiplatelet Therapy ◽

Meta Analysis ◽

Systemic Review ◽

Transcatheter Aortic Valve

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A SYSTEMIC REVIEW AND META-ANALYSIS OF VALVE IN VALVE TRANSCATHETER AORTIC VALVE REPLACEMENT COMPARING BALLOON AND SELF EXPANDING VALVES

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)31880-5 ◽

2020 ◽

Vol 75 (11) ◽

pp. 1253

Author(s):

Garry Hamilton ◽

Anoop Koshy ◽

Alexandra Murphy ◽

Jordan Fulcher ◽

James Theuerle ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Meta Analysis ◽

Systemic Review ◽

Transcatheter Aortic Valve ◽

Valve In Valve

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Faculty Opinions recommendation of Impact of right ventricular dysfunction and tricuspid regurgitation on outcomes in patients undergoing transcatheter aortic valve replacement.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726847452.793524426 ◽

2016 ◽

Author(s):

John Augoustides

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Right Ventricular ◽

Valve Replacement ◽

Tricuspid Regurgitation ◽

Transcatheter Aortic Valve Replacement ◽

Ventricular Dysfunction ◽

Right Ventricular Dysfunction ◽

Transcatheter Aortic Valve

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Faculty Opinions recommendation of Thirty-day readmissions in surgical and transcatheter aortic valve replacement: A systematic review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733272410.793546441 ◽

2018 ◽

Author(s):

John Augoustides

Keyword(s):

Systematic Review ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Meta Analysis ◽

Transcatheter Aortic Valve

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Aortic Annular Sizing Using Novel Software in Three-Dimensional Transesophageal Echocardiography for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Diagnostics ◽

10.3390/diagnostics11050751 ◽

2021 ◽

Vol 11 (5) ◽

pp. 751

Author(s):

Chanrith Mork ◽

Minjie Wei ◽

Weixi Jiang ◽

Jianli Ren ◽

Haitao Ran

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Transesophageal Echocardiography ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Meta Analysis ◽

Three Dimensional ◽

Minimum Diameter ◽

Transcatheter Aortic Valve ◽

Mean Differences

(1) Background: We performed this study to evaluate the agreement between novel automated software of three-dimensional transesophageal echocardiography (3D-TEE) and multidetector computed tomography (MDCT) for aortic annular measurements of preprocedural transcatheter aortic valve replacement (TAVR); (2) Methods: PubMed, EMBASE, Web of Science, and Cochrane Library (Wiley) databases were systematically searched for studies that compared 3D-TEE and MDCT as the reference standard for aortic annular measurement of the following parameters: annular area, annular perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter. Meta-analytic methods were utilized to determine the pooled correlations and mean differences between 3D-TEE and MDCT. Heterogeneity and publication bias were also assessed. Meta-regression analyses were performed based on the potential factors affecting the correlation of aortic annular area; (3) Results: A total of 889 patients from 10 studies were included in the meta-analysis. Pooled correlation coefficients between 3D-TEE and MDCT of annulus area, perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter measurements were strong 0.89 (95% CI: 0.84–0.92), 0.88 (95% CI: 0.83–0.92), 0.87 (95% CI: 0.77–0.93), 0.87 (95% CI: 0.77–0.93), 0.79 (95% CI: 0.64–0.87), and 0.75 (95% CI: 0.61–0.84) (Overall p < 0.0001), respectively. Pooled mean differences between 3D-TEE and MDCT of annulus area, perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter measurements were −20.01 mm2 ((95% CI: −35.37 to −0.64), p = 0.011), −2.31 mm ((95% CI: −3.31 to −1.31), p < 0.0001), −0.22 mm ((95% CI: −0.73 to 0.29), p = 0.40), −0.47 mm ((95% CI: −1.06 to 0.12), p = 0.12), −1.36 mm ((95% CI: −2.43 to −0.30), p = 0.012), and 0.31 mm ((95% CI: −0.15 to 0.77), p = 0.18), respectively. There were no statistically significant associations with the baseline patient characteristics of sex, age, left ventricular ejection fraction, mean transaortic gradient, and aortic valve area to the correlation between 3D-TEE and MDCT for aortic annular area sizing; (4) Conclusions: The present study implies that 3D-TEE using novel software tools, automatically analysis, is feasible to MDCT for annulus sizing in clinical practice.

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