Role of the tricuspid regurgitation after mitraclip and transcatheter aortic valve implantation: a systematic review and meta-analysis

Aims Treatment of tricuspid regurgitation (TR) is common after surgery for mitral and/or aortic valves. The prognostic role of moderate to severe TR in patients undergoing mitraclip or transcatheter aortic valve implantation (TAVI) is not well-defined. Thus, the aim of this article is to perform a systematic review and meta-analysis of articles valuing the prognostic role of TR for patients undergoing mitraclip and TAVI. Methods and results Articles were searched in Pubmed, Cochrane Library, Google Scholar and Biomed Central in September 2016. Inclusion criteria: observational or randomized clinical trials with data on the prognostic role of TR in patients undergoing mitraclip or TAVI. Primary outcome was all-cause mortality expressed as hazard ratio (HR). Six articles fulfilled inclusion criteria, three were on mitraclip and three on TAVI. A total of 2329 patients were analysed (mean age was 78.38 (3.09), 63% male): 1328 treated with TAVI and 1001 with mitraclip. The HR for all-cause mortality of moderate to severe TR was 2.0 (95% CI 1.57-2.55, I-2 = 0%). Data were confirmed also after subgroup analysis for mitraclip vs. TAVI. None of the factor considered in meta-regression analyses was affecting the primary outcome. Conclusions The current meta-analysis suggests that the presence of moderate to severe TR in patients undergoing mitraclip or TAVI might be a major determinant of all-cause mortality. New studies are needed to confirm it and to plan possible intervention in order to reduce its impact.