Worse survival in transcatheter aortic valve replacement with untreated tricuspid regurgitation: Implications for surgical intervention.

Abstract

Tricuspid regurgitation (TR) is frequently seen in patients with aortic stenosis; however, there is currently no guidance regarding the management of patients with aortic stenosis with TR being considered for transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement. This study evaluates long-term outcomes of functional TR in patients with TAVR. All patients undergoing TAVR at a single institution from 2011 to 2022 with complete pre- and post-TAVR echocardiogram follow-up were stratified by preprocedure TR grade (none, mild, moderate, or severe). Primary outcomes were TR improvement or persistence/progression, and long-term survival. Time-to-event analysis and Cox proportional hazards models were used to compare long-term mortality. Median time to most recent post-TAVR echocardiogram was 12 months, and median clinical follow-up was 24 months. Of 1668 patients with TAVR in the study cohort, 55% (n = 925) had TR of any severity. TR persisted in 70% of these patients, although few ever underwent later TR intervention. Moderate-severe TR was found in 20% (n = 331) of patients and persisted or worsened in 47% of cases. Moderate-severe TR was associated with worse unadjusted median survival when compared with patients with no-to-mild TR (median survival, 39 vs 62 months; P < .001). Adjusting for age, sex, surgical risk, and other noncardiac and cardiac comorbidities, including mitral regurgitation, moderate-to-severe TR was an independent predictor of worse survival (hazard ratio, 1.39; P = .004). Degree of TR is unlikely to improve following TAVR. Moderate-severe TR was a predictor of worse long-term survival. The presence of concurrent moderate or severe TR should be considered when deciding between transcatheter and surgical approaches.