Key result
Severe post-TMVr tricuspid regurgitation is linked to ~24-point lower 2-year survival.
Why the study?
TR frequently coexists with symptomatic MR and increases morbidity and mortality, but its clinical course after TMVR has not been clearly determined.
Does severe tricuspid regurgitation at 6 months after transcatheter mitral valve repair predict worse survival in patients with severe mitral regurgitation?
Cohort (n=146)
No
Does severe tricuspid regurgitation at 6 months after transcatheter mitral valve repair predict worse survival in patients with severe mitral regurgitation?
Absolute Event Rate: 58% vs 82%
p-value: p=<0.001
Persistent severe tricuspid regurgitation after TMVR predicts worse 2-year survival, highlighting the potential need for earlier intervention in MR to prevent irreversible right-sided changes.
Persistent severe TR post-TMVR may warrant closer monitoring; leaves open whether targeted intervention improves outcomes.
OBJECTIVES: The aim of this study was to determine the course of tricuspid regurgitation (TR) after transcatheter mitral valve repair (TMVR), identify predictors for severe TR after TMVR and determine the association of severe TR after TMVR with outcome. BACKGROUND: TR is often present in patients with symptomatic mitral regurgitation (MR) and is associated with increased morbidity and mortality. The clinical course of TR after TMVR has not been clearly determined. METHODS: Patients that underwent TMVR between 2009 and 2017 were included. Clinical data were compared between patients with and without severe TR at 6 months after TMVR. Multivariate logistic regression analysis was performed to identify predictors for severe TR after TMVR. Survival analysis was done for both groups, using the Kaplan-Meier method. RESULTS: A total of 146 patients were included (mean age 76 years, 51% male, 79% New York Heart Association class ≥3 and 29% severe TR at baseline). Advanced age, atrial fibrillation (AF), right ventricular (RV) dysfunction, and limited procedural MR reduction were revealed as independent predictors for severe TR after TMVR. Survival of patients with severe TR after TMVR was 58% after 2 years compared to 82% for those with non, mild or moderate TR. CONCLUSIONS: Severe TR after TMVR is common in patients at advanced age, those with AF, RV dysfunction and limited MR reduction during TMVR and is associated with impaired survival. As the associated parameters are indicators of longstanding MR, research investigating the benefits of earlier intervention in MR should be initiated.
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Meijerink et al. (2021) conducted a cohort in Symptomatic severe mitral regurgitation (n=146). Severe tricuspid regurgitation at 6 months after TMVR vs. Non, mild or moderate tricuspid regurgitation at 6 months after TMVR was evaluated on Survival at 2 years (p=<0.001). Severe tricuspid regurgitation at 6 months after transcatheter mitral valve repair was associated with significantly lower 2-year survival compared to less severe regurgitation (58% vs 82%, p<0.001).
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