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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:357-64 - Vol. 71 Num.05 DOI: 10.1016/j.rec.2017.08.019

Tricuspid but not Mitral Regurgitation Determines Mortality After TAVI in Patients With Nonsevere Mitral Regurgitation

Ignacio J. Amat-Santos a,, Javier Castrodeza a, Luis Nombela-Franco b, Antonio J. Muñoz-García c, Enrique Gutiérrez-Ibanes d, José M. de la Torre Hernández e, Juan G. Córdoba-Soriano f, Pilar Jiménez-Quevedo b, José M. Hernández-García c, Ana González-Mansilla d, Javier Ruano e, Javier Tobar a, María Del Trigo b, Silvio Vera a, Rishi Puri g, Carolina Hernández-Luis a, Manuel Carrasco-Moraleja a, Itziar Gómez a, Josep Rodés-Cabau g, José A. San Román a

a Departamento de Cardiología, CIBERCV, Hospital Clínico Universitario, Valladolid, Spain
b Departamento de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, Spain
c Departamento de Cardiología, Hospital Clínico Virgen de la Victoria, Málaga, Spain
d Departamento de Cardiología, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
e Departamento de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
f Departamento de Cardiología, Hospital General Universitario, Albacete, Spain
g Departament of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada

Keywords

Mitral regurgitation. Tricuspid regurgitation. Transcatheter aortic valve implantation. Multivalvular disease.

Abstract

Introduction and objectives

Many patients undergoing transcatheter aortic valve implantation (TAVI) have concomitant mitral regurgitation (MR) of moderate grade or less. The impact of coexistent tricuspid regurgitation (TR) remains to be determined. We sought to analyze the impact of moderate vs none-to-mild MR and its trend after TAVI, as well as the impact of concomitant TR and its interaction with MR.

Methods

Multicenter retrospective study of 813 TAVI patients treated through the transfemoral approach with MR ≤ 2 between 2007 and 2015.

Results

The mean age was 81 ± 7 years and the mean Society of Thoracic Surgeons score was 6.9% ± 5.1%. Moderate MR was present in 37.3% of the patients, with similar in-hospital outcomes and 6-month follow-up mortality to those with MR < 2 (11.9% vs 9.4%; P = .257). However, they experienced more rehospitalizations and worse New York Heart Association class (P = .008 and .001, respectively). Few patients (3.8%) showed an increase in the MR grade to > 2 post-TAVI. The presence of concomitant moderate/severe TR was associated with in-hospital and follow-up mortality rates of 13% and 34.1%, respectively, regardless of MR grade. Moderate-severe TR was independently associated with mortality (HR, 18.4; 95%CI, 10.2-33.3; P < .001).

Conclusions

The presence of moderate MR seemed not to impact short- and mid-term mortality post-TAVI, but was associated with more rehospitalizations. The presence of moderate or severe TR was associated with higher mortality. This suggests that a thorough evaluation of the mechanisms underlying concomitant mitral and tricuspid valve regurgitation should be performed to determine the best strategy for avoiding TAVI-related futility.

1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved