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.
CHARACTERISTICS OF PERSISTENT TRICUSPID REGURGITATION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT
