Key result
Baseline moderate or severe tricuspid regurgitation increased all-cause mortality after TAVR (HR 1.79; 95% CI 1.52-2.11; P<0.001), as did baseline RV dysfunction and RV dilation.
Why the study?
Far less attention has been paid to the prognostic effect of right-side heart disease on outcomes after TAVR compared with left-side heart disease.
Does baseline moderate or severe tricuspid regurgitation and right ventricular dysfunction increase all-cause mortality in patients undergoing TAVR?
Meta-Analysis (n=6,466)
Does baseline moderate or severe tricuspid regurgitation and right ventricular dysfunction increase all-cause mortality in patients undergoing TAVR?
Hazard Ratio: 1.79 (95% CI 1.52–2.11)
p-value: p=< 0.001
Baseline moderate or severe tricuspid regurgitation and right ventricular dysfunction are associated with significantly increased all-cause mortality after TAVR, highlighting the importance of right heart assessment prior to the procedure.
Supports pre-TAVR right heart evaluation; reinforces prognostic importance of TR and RV dysfunction.
Far less attention has been paid to the prognostic effect of right-side heart disease on outcomes after transcatheter aortic valve replacement (TAVR) when compared with the left side. Therefore, we performed a systematic review and meta-analysis on the impact of tricuspid regurgitation (TR) and right ventricular (RV) dysfunction on outcomes after TAVR. We hypothesized that TR and RV dysfunction may have a deleterious effect on outcomes after TAVR. Article revealing the prognostic effect of TR and RV dysfunction on outcomes after TAVR were being integrated. Random or fixed effect model was adopted in accordance with the heterogeneity. There were nine studies with a total of 6466 patients enrolled after a comprehensive literature search of the MEDLINE/PubMed, EMBASE, ISI Web of Science, and Cochrane databases. The overall analysis revealed that moderate or severe TR at baseline increased all-cause mortality after TAVR (HR = 1.79, CI 95% 1.52-2.11, P < 0.001). Both baseline RV dysfunction (HR = 1.53, CI 95% 1.27-1.83, P < 0.001) and presence of RV dilation (HR = 1.83, CI 95% 1.47-2.27, P < 0.001) were associated with all-cause mortality. Both baseline moderate or severe TR and RV dysfunction worsen prognosis after TAVR and careful assessment of right heart function should be done for clinical decision by the heart team before the TAVR procedure.
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Fan et al. (2018) conducted a meta-analysis in Transcatheter aortic valve replacement (TAVR) (n=6,466). Moderate or severe tricuspid regurgitation (TR) vs. None or mild TR was evaluated on All-cause mortality (HR 1.79, 95% CI 1.52-2.11, p=< 0.001). Baseline moderate or severe tricuspid regurgitation increased all-cause mortality after TAVR (HR 1.79; 95% CI 1.52-2.11; P<0.001), as did baseline RV dysfunction and RV dilation.
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