Prognostic implication of right ventricular dysfunction and tricuspid regurgitation following transcatheter aortic valve replacement

Yoav Granot, Ilan Merdler, Ariel Finkelstein, Yaron Arbel, Shmuel Banai, Yan Topilsky, Lorin Arie Scwartz, Amit Segev, Israel Barbash, Paul Fefer, Haim Danenberg, Mony Shuvy, Gidon Perlman, Ran Kornowski, Yaron Shapira, Katia Orvin, Arie Steinvil

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Right ventricular (RV) dysfunction and tricuspid regurgitation (TR) are associated with adverse outcomes in severe aortic stenosis (AS) patients. Our aim was to evaluate the association between ≥moderate TR and RV dysfunction on long-term mortality following transcatheter aortic valve replacement (TAVR). Methods: A retrospective analysis of the Israeli multicenter TAVR registry among 4,344 consecutive patients, with all-cause mortality as the main outcome measure. Results: Echocardiographic assessment of TR grade and RV dysfunction was available for 3,733 and 1,850 patients, of whom ≥moderate TR and RV dysfunction was noted for 478(13%) and 78(4%), respectively. The mean follow-up time was 2.9 ± 2.3 years. In univariate models, ≥Moderate TR and ≥moderate RV dysfunction were associated with increased long-term mortality (HR 1.45, 95% CI 1.24–1.69, p <.001 and HR 1.73, 95% CI 1.21–2.47, p = 0.003, respectively). These finding did not remained significant after adjusting to echocardiographic parameters. A subset of patients with no improvement in RV function had the highest long-term mortality risk (HR 3.3, 95% CI 1.95–5.7, p <.001). Conclusion: When adjusted to multiple echocardiographic characteristics baseline ≥Moderate TR and ≥moderate RV dysfunction were not associated with long-term mortality following TAVR. Persistent RV dysfunction following TAVR was associated with the highest risk for mortality.

Original languageEnglish
Pages (from-to)E758-E767
JournalCatheterization and Cardiovascular Interventions
Volume98
Issue number5
DOIs
StatePublished - 1 Nov 2021

Keywords

  • ITTE
  • TTE/TEE
  • aortic valve disease (AVDP)
  • imaging
  • percutaneous intervention
  • transcatheter valve implantation (TVI)

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