Impact of Moderate or Severe Mitral and Tricuspid Valves Regurgitation after Transcatheter Aortic Valve Replacement

Bishoy Abraham; Mustafa Suppah; Juan Farina; Michael Botros; Ayman Fath; Sara Kaldas; Michael Megaly; Chieh-Ju Chao; Reza Arsanjani; Chadi Ayoub; F David Fortuin; John Sweeney; Patricia Pellikka; Vuyisile Nkomo; Mohamad Alkhouli; David Holmes Jr; Amr Badr; Said Alsidawi

doi:10.1016/j.ahj.2024.11.003

Impact of Moderate or Severe Mitral and Tricuspid Valves Regurgitation after Transcatheter Aortic Valve Replacement

Am Heart J. 2024 Nov 12:S0002-8703(24)00295-3. doi: 10.1016/j.ahj.2024.11.003. Online ahead of print.

Authors

Bishoy Abraham¹, Mustafa Suppah², Juan Farina², Michael Botros², Ayman Fath², Sara Kaldas², Michael Megaly³, Chieh-Ju Chao⁴, Reza Arsanjani², Chadi Ayoub², F David Fortuin², John Sweeney², Patricia Pellikka⁴, Vuyisile Nkomo⁴, Mohamad Alkhouli⁴, David Holmes Jr⁴, Amr Badr², Said Alsidawi²

Affiliations

¹ Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ; Division of Cardiology, Columbia University, Mount Sinai Medical Center, Miami, FL. Electronic address: bisho.abraham@gmail.com.
² Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ.
³ Division of Cardiology, Henry Ford Hospital, Detroit, MI.
⁴ Division of Cardiology, Mayo Clinic Hospital, Rochester, MN.

PMID: 39542233
DOI: 10.1016/j.ahj.2024.11.003

Abstract

Background: Tricuspid regurgitation (TR) and mitral regurgitation (MR) are common valvular conditions encountered in patients undergoing transcatheter aortic valve replacement (TAVR). This retrospective study investigates the impact of moderate or severe TR and MR on all-cause mortality in one-year post-TAVR patients.

Methods: Consecutive patients who underwent TAVR at the 3 academic tertiary care centers in our health system between 2012 and 2018 were identified. Patients were stratified into 2 groups based on valvular regurgitation severity: moderate/severe MR vs. no/mild MR, and moderate/severe TR vs. no/mild TR. Primary outcome was all-cause mortality at 1-year and 5-year follow up, and secondary outcome was in-hospital death. Logistic regression analysis was conducted to assess the relationship between moderate/severe MR or TR and all-cause mortality at 1-year and 5-year follow-up.

Results: We included a total of 1,071 patients who underwent TAVR with mean age 80.9 ± 8.6 years, 97% white, and 58.3% males. Moderate or severe MR group included 52 (4.88%) patients while mild or no MR group included 1,015 (95.12%) patients. There was no significant difference between both groups in TAVR procedure success rate (100% vs. 97.83%, p=0.283), in-hospital mortality (0 vs. 1.08%, p=0.450), or mortality at 1-year follow up (15.38% vs. 14.09%, p=0.794). At 5-year follow up, moderate/severe MR group had higher mortality (61.4% vs. 49.5%, p=0.046). In multivariable logistic regression analysis, moderate or severe MR did not show significant correlation with all-cause mortality at 1-year and 5-year follow up. Moderate or severe TR group included 86 (8.03%) patients while mild or no TR group included 985 (91.97%) patients. There was no difference between both groups in TAVR procedure success (98.8% vs. 97.9%, p=0.54) or in-hospital mortality (0% vs. 1.1%, p=0.33). At 1-year follow up, patients with moderate or severe TR had higher mortality (26.7% vs. 13.2%, p=0.001) compared to patients with mild or no TR. Same finding was noted with extended follow up at 5-years (68.3% vs. 48.7%, p<0.001). In multivariable cox regression analysis, moderate/severe TR was associated with higher all-cause mortality at 1-year (OR 1.94, 95% CI [01.09, 3.44], p=0.0.023) and at 5-year (OR 1.46, 95% CI [1.092, 1.952], p=0.0.011) follow up. Patients with combined moderate/severe MR and TR have even higher mortality compared to either moderate/severe valve regurgitation alone or mild/no valve regurgitation at 5-year follow up.

Conclusion: At long term follow up, moderate/severe TR, but not MR, is associated with higher mortality in patients underwent TAVR. Combined moderate/severe TR and MR had even worse mortality. Careful assessment of multi-valvular heart disease prior to the procedure is warranted.