Premium
Prevalence and impact of preoperative moderate/severe tricuspid regurgitation on patients undergoing transcatheter aortic valve replacement
Author(s) -
Barbanti Marco,
Binder Ronald K.,
Dvir Danny,
Tan John,
Freeman Melanie,
Thompson Christopher R.,
Cheung Anson,
Wood David A.,
Leipsic Jonathon,
Webb John G.
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25512
Subject(s) - medicine , cardiology , regurgitation (circulation) , confidence interval , valve replacement , valvular heart disease , aortic valve replacement , tricuspid valve , log rank test , ejection fraction , aortic valve , heart failure , survival analysis , stenosis
Objectives Significant tricuspid regurgitation (TR) is a marker for late‐stage myocardial and valvular heart disease. Whether preoperative TR affects clinical outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) has never been investigated. This study sought to identify the impact of moderate and severe TR on outcomes after TAVR. Methods All patients undergoing TAVR from January 2007 to August 2012 at St. Paul's Hospital, Vancouver, Canada, ( n = 518) were dichotomized according to the severity of preoperative TR (moderate/severe vs. none/mild). All clinical outcomes were defined according to the valve academic research consortium‐2 definitions. Results At baseline, moderate or severe TR was reported in 79 patients (15.2%). At 30 days, moderate/severe TR had improved in 12 patients (15.2%), was unchanged in 46 patients (58.3%), and worsened in 7 patients (8.9%). Of those with none/mild TR at baseline, 35 (7.9%) patients had moderate TR at 30‐day follow‐up. Two‐year all‐cause (38.4% vs. 20.0%, Log‐rank test, P = 0.001) and cardiac mortality (12.9% vs. 4.6%, Log‐rank test, P = 0.004) as estimated by Kaplan‐Meier analysis were considerably higher in patients with significant TR. However, significant TR did not emerge as independent risk factor for 2‐year all‐cause mortality (adjusted OR: 1.55, 95% confidence interval (CI): 0.91–2.64, P = 0.105). Pre‐specified subgroups showed an interaction between TR and left ventricular systolic function ( P interaction = 0.047). Indeed, moderate/severe TR was significantly related to mortality only in patients with left ventricular ejection fraction (LVEF) > 40% (adjusted OR: 2.01, CI: 1.05–3.84, P = 0.036). In patients with LVEF ≤ 40%, TR had no significant impact on all‐cause mortality (adjusted OR: 1.04, CI: 0.34–3.16, P = 0.946). No significant interactions were identified regarding patients with perioperative moderate/severe mitral regurgitation ( P interaction = 0.829) and patients with baseline systolic pulmonary artery pressure ≥ 60 mm Hg ( P interaction = 0.669). Conclusions 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. © 2014 Wiley Periodicals, Inc.