Journal
JACC-CARDIOVASCULAR INTERVENTIONS
Volume 14, Issue 20, Pages 2246-2256Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcin.2021.07.030
Keywords
aortic stenosis; transcatheter aortic valve replacement; transcatheter tricuspid valve interventions; tricuspid regurgitation
Categories
Funding
- Abbott
- Amgen
- AstraZeneca
- Bristol Myers Squibb
- Bayer
- Biotronik
- Boston Scientific
- Cardinal Health
- CardioValve
- CSL Behring
- Daiichi-Sankyo
- Edwards Lifesciences
- Guerbet
- InfraRedx
- Johnson Johnson
- Medicure
- Medtronic
- Novartis
- Polares
- OrPha Suisse
- Pfizer
- Regeneron
- Sanofi
- Sinomed
- Terumo
- V-Wave
- Abiomed
- Med Alliance
- Xeltis
- Pfizer Research Award selection committee in Switzerland
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A significant proportion of patients were deemed potential candidates for TTVI after TAVR, with impaired prognosis and persistently impaired functional status at 1 year after the procedure.
OBJECTIVES The aims of this study were to document the prevalence of concomitant tricuspid regurgitation (TR) before and after transcatheter aortic valve replacement (TAVR), to quantify potential eligibility for transcatheter tricuspid valve intervention (TTVI), and to report clinical outcomes as a function of the severity of TR and potential candidacy for TTVI. BACKGROUND The importance of concomitant TR in patients with severe aortic stenosis undergoing TAVR remains unclear. METHODS In a prospective TAVR registry, the severity of TR before and after TAVR was retrospectively evaluated in an echocardiography core laboratory. RESULTS Among 2,008 eligible patients, 1,659 patients (82.6%) had mild or less TR, 242 (12.1%) had moderate TR, 57 (2.8%) had severe TR, and 50 (2.5%) had massive TR. More than one-half of patients with moderate or greater TR had a reduction in TR, while a small proportion of patients with severe or less of TR had worsening of TR after TAVR. In contrast to TR at baseline, severe TR (adjusted HR [HRadjusted]: 1.90; 95% CI: 1.03-3.49) and massive TR (HRadjusted: 2.17; 95% CI: 1.10-4.30) after TAVR conferred an increased risk for mortality compared with mild or less TR at 1 year after TAVR. After TAVR, 63 patients (3.1%) were deemed potential candidates for TTVI. They had a 2-fold increased risk for mortality between 30 days and 1 year (HRadjusted: 1.93; 95% CI: 1.15-3.25) and a higher risk for persistent heart failure symptoms (adjusted risk ratio: 2.80; 95% CI: 1.78-4.40). CONCLUSIONS A non-negligible proportion of patients were considered potential candidates for TTVI after TAVR and had impaired prognosis and persistently impaired functional status at 1 year. (SwissTAVI Registry; NCT01368250) (C) 2021 by the American College of Cardiology Foundation.
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