Tricuspid Regurgitation and TAVR: Outcomes, Risk Factors and Biomarkers.
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UNIL restricted access
State: Public
Version: author
License: CC BY 4.0
Serval ID
serval:BIB_7E8814938346
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Tricuspid Regurgitation and TAVR: Outcomes, Risk Factors and Biomarkers.
Journal
Journal of clinical medicine
ISSN
2077-0383 (Print)
ISSN-L
2077-0383
Publication state
Published
Issued date
04/03/2024
Peer-reviewed
Oui
Volume
13
Number
5
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Abstract
Background. The significance of concomitant tricuspid regurgitation (TR) in the context of transcatheter aortic valve replacement (TAVR) remains unclear. This study aimed to analyze the severity of TR before and after TAVR with regard to short- and long-term survival and to analyze the influencing factors. Methods. In our retrospective analysis, TR before and after TAVR was examined and patients were classified into groups accordingly. Special attention was paid to patients with post-interventional changes in TR. Mortality after TAVR was considered the primary endpoint of the analysis and major complications according to the Valve Academic Research Consortium 3 (VARC3) were compared. Moreover, biomarkers and risk factors for worsening or improvement of TR through TAVR were analyzed. Results. Among 775 patients who underwent TAVR in our center between January 2009 and December 2019, 686 patients (89%) featured low- and 89 patients (11%) high-grade TR. High-grade pre-TAVR TR was associated with worse short- (30-day), mid- (2-year) and long-term survival up to 8 years. Even though in nearly half of the patients with high-grade TR the regurgitation improved within seven days after TAVR (n = 42/89), this did not result in a survival benefit for this subgroup. On the other hand, a worsening of low-grade TR was seen in more than 10% of the patients (n = 73/686), which was also associated with a worse prognosis. Predictors of worsening of TR after TAVR were adipositas, impaired right ventricular function and the presence of mild TR. Age, atrial fibrillation, COPD, impaired renal function and elevated cardiac biomarkers were risk factors for mortality after TAVR independent from the grade of TR. Conclusions. Not only pre-interventional, but also post-TAVR high-grade TR is associated with a worse prognosis after TAVR. TAVR can change concomitant tricuspid regurgitation, but improvement does not have any impact on short- and long-term survival. Worsening of TR after TAVR is possible and impairs the prognosis.
Keywords
N-terminal pro-B-type natriuretic peptide, TAVR, TR grading, aortic stenosis, high sensitivity troponin T, implantation, transcatheter aortic valve replacement, tricuspid insufficiency, tricuspid regurgitation, tricuspid valve
Pubmed
Web of science
Open Access
Yes
Create date
17/01/2025 5:24
Last modification date
24/02/2025 12:08