Impact of concurrent tricuspid regurgitation on mortality after transcatheter aortic‐valve implantation

AbstractObjectivesTo determine whether concomitant tricuspid regurgitation (TR) is associated with increased mortality in patients with severe aortic stenosis (AS) undergoing transcatheter aortic‐valve implantation (TAVI), we performed a meta‐analysis of currently available studies.MethodsMEDLINE and EMBASE were searched through May 2018. We included comparative or cohort studies enrolling patients with AS undergoing TAVI and reporting early (in‐hospital or 30‐day) and late (including early) all‐cause mortality in patients stratified by baseline TR grade. An odds ratio (OR) of early mortality and a hazard ratio (HR) of late mortality with its 95% CI for significant versus non‐significant (typically, ≥moderate versus <moderate) TR was extracted. Study‐specific estimates were combined in the random‐effects model.ResultsOur search identified 12 eligible studies enrolling a total of 41,485 TAVI patients. The meta‐analysis for early mortality combining 3 ORs demonstrated a significant 1.80‐fold increase in mortality with significant TR (OR, 1.80; 95% CI, 1.01 to 3.19; P = 0.05). The primary meta‐analysis for midterm (6‐month to 30‐month) mortality combining all the 12 HRs/ORs indicated a significant 1.96‐fold increase in mortality (HR/OR, 1.96; 95% CI, 1.35 to 2.85; P = 0.0004). The secondary meta‐analysis for midterm mortality combining 7 homogeneous HRs (adjusted HRs for ≥moderate versus <moderate TR) showed a significant 2.25‐fold increase in mortality (HR, 2.25; 95% CI, 1.20–4.24; P = 0.01).ConclusionsConcurrent significant (typically, ≥moderate) TR is associated with an approximately two‐fold increase in both early and midterm all‐cause mortality in patients with AS undergoing TAVI.