TY - JOUR
T1 - Aortic Stenosis with Severe Tricuspid Regurgitation
T2 - Comparative Study between Conservative Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Combined With Tricuspid Repair
AU - Rozenbaum, Zach
AU - Granot, Yoav
AU - Steinvil, Arie
AU - Banai, Shmuel
AU - Finkelstein, Ariel
AU - Ben-Gal, Yanai
AU - Keren, Gad
AU - Topilsky, Yan
N1 - Publisher Copyright:
© 2018 American Society of Echocardiography
PY - 2018/10
Y1 - 2018/10
N2 - Background: Severe aortic stenosis (AS) and severe tricuspid regurgitation (TR) may coexist. The aim of this study was to determine the change in right ventricular (RV) function and TR after surgical aortic valve replacement combined with tricuspid valve repair (SAVR+TVr), transcatheter aortic valve replacement (TAVR), or conservative management and compare outcomes dependent on RV functional parameters and treatment allocation. Methods: A retrospective analysis was conducted in 147 consecutive patients with severe AS and TR of baseline and 6-month clinical and echocardiographic parameters, including quantitative estimation of RV size and function (end-diastolic and end-systolic areas, tricuspid annular plane systolic excursion, fractional area change, and Tei index). Results: SAVR+TVr and TAVR were associated with superior reduction in TR jet area after 6 months (P =.01 for time × group interaction) compared with conservative therapy. However, RV function (tricuspid annular plane systolic excursion and stroke volume) improved after TAVR but not after SAVR+TVr (P =.007 and P =.02 for time × group interaction, respectively). Conservative therapy for combined AS and TR was associated with >80% mortality in <4 years. TAVR and SAVR+TVr were associated with improved survival compared with conservative therapy (P <.0001), without significant difference between each other. Quantitative RV functional parameters were associated with poor outcomes, including tricuspid annular plane systolic excursion (P =.002), Tei index (P =.02), and RV fractional area change (P =.03). Conclusions: In this nonrandomized, retrospective, observational study, SAVR+TVr and TAVR were associated with reductions in TR in patients with severe AS combined with severe TR. Importantly, RV function improved after TAVR but not after SAVR+TVr. Patients with severe AS and TR have a very poor prognosis with conservative therapy. When contemplating invasive procedures, assessment should include quantitative functional RV parameters.
AB - Background: Severe aortic stenosis (AS) and severe tricuspid regurgitation (TR) may coexist. The aim of this study was to determine the change in right ventricular (RV) function and TR after surgical aortic valve replacement combined with tricuspid valve repair (SAVR+TVr), transcatheter aortic valve replacement (TAVR), or conservative management and compare outcomes dependent on RV functional parameters and treatment allocation. Methods: A retrospective analysis was conducted in 147 consecutive patients with severe AS and TR of baseline and 6-month clinical and echocardiographic parameters, including quantitative estimation of RV size and function (end-diastolic and end-systolic areas, tricuspid annular plane systolic excursion, fractional area change, and Tei index). Results: SAVR+TVr and TAVR were associated with superior reduction in TR jet area after 6 months (P =.01 for time × group interaction) compared with conservative therapy. However, RV function (tricuspid annular plane systolic excursion and stroke volume) improved after TAVR but not after SAVR+TVr (P =.007 and P =.02 for time × group interaction, respectively). Conservative therapy for combined AS and TR was associated with >80% mortality in <4 years. TAVR and SAVR+TVr were associated with improved survival compared with conservative therapy (P <.0001), without significant difference between each other. Quantitative RV functional parameters were associated with poor outcomes, including tricuspid annular plane systolic excursion (P =.002), Tei index (P =.02), and RV fractional area change (P =.03). Conclusions: In this nonrandomized, retrospective, observational study, SAVR+TVr and TAVR were associated with reductions in TR in patients with severe AS combined with severe TR. Importantly, RV function improved after TAVR but not after SAVR+TVr. Patients with severe AS and TR have a very poor prognosis with conservative therapy. When contemplating invasive procedures, assessment should include quantitative functional RV parameters.
KW - Aortic stenosis (AS)
KW - Surgical aortic valve replacement
KW - Transcatheter aortic valve replacement
KW - Tricuspid regurgitation
UR - http://www.scopus.com/inward/record.url?scp=85051374312&partnerID=8YFLogxK
U2 - 10.1016/j.echo.2018.07.002
DO - 10.1016/j.echo.2018.07.002
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AN - SCOPUS:85051374312
SN - 0894-7317
VL - 31
SP - 1101
EP - 1108
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 10
ER -
