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

Transcatheter aortic valve implantation (TAVI) has rapidly evolved during the past decade and is now well established for the treatment of patients with severe, symptomatic stenosis at increased surgical risk. Results from randomized clinical trials reported long-term outcomes, which were comparable or superior to surgical aortic valve replacement (SAVR) among patients at intermediate to high surgical risk.1,2 Over the years, technological advancement in valve design and delivery, optimized peri-interventional medical management, and, not least, improved patient selection have led to breathtaking improvements in periprocedural outcomes. This development has been recently highlighted by the report of the 30-day results of the Placement of Aortic Transcatheter Valve (PARTNER) II S3 trial performed in high (Society of Thoracic Surgeons [STS] score, 8.6%) and intermediate risk (mean STS score, 5.3%) patients. Using the Edwards Sapien 3 system (Edwards Lifesciences, Irvine, CA), the investigators reported exceedingly low rates of mortality (2.2% and 1.1% in the high- and intermediate-risk cohort, respectively), with an observed to estimated (STS score based) ratio of mortality of 0.26 in the high-risk cohort and 0.21 in the intermediate-risk cohort. For the purpose of comparison, the 30-day mortality in the transcatheter group of the PARTNER A trial amounted to 5.2% with an observed to estimated mortality ratio of 0.44.3 Notwithstanding, despite the indisputable benefits of TAVI, the recently published long-term data from the PARTNER B trial highlighted the high mortality (72%) and readmission rates (48%) within 5 years of follow-up among inoperable TAVI patients.4 Ideally, improvements in clinical outcomes after TAVI should go beyond a reduction in mortality and also address improvements in quality of life. Therefore, it is of pivotal importance for the Heart Team to identify patients and lesions who benefit most from this intervention.See Article by Lindman et al Several independent predictors of …