Potential Candidates for Transcatheter Tricuspid Valve Intervention After Transcatheter Aortic Valve Replacement: Predictors and Prognosis.

Tomii, Daijiro; Okuno, Taishi; Praz, Fabien; Heg, Dik; Wild, Mirjam Gauri; Lanz, Jonas; Stortecky, Stefan; Reineke, David; Windecker, Stephan; Pilgrim, Thomas (2021). Potential Candidates for Transcatheter Tricuspid Valve Intervention After Transcatheter Aortic Valve Replacement: Predictors and Prognosis. JACC. Cardiovascular Interventions, 14(20), pp. 2246-2256. Elsevier 10.1016/j.jcin.2021.07.030

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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 hazard ratio [HRadjusted]: 1.90; 95% confidence interval [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).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Okuno, Taishi; Praz, Fabien Daniel; Heg, Dierik Hans; Wild Winkel, Mirjam Gauri; Lanz, Jonas; Stortecky, Stefan; Reineke, David Christian; Windecker, Stephan and Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

08 Oct 2021 12:06

Last Modified:

08 Nov 2021 09:24

Publisher DOI:

10.1016/j.jcin.2021.07.030

PubMed ID:

34600873

Additional Information:

Tomii and Okuno contributed equally to this work.

Uncontrolled Keywords:

aortic stenosis transcatheter aortic valve replacement transcatheter tricuspid valve interventions tricuspid regurgitation

BORIS DOI:

10.48350/159869

URI:

https://boris.unibe.ch/id/eprint/159869

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