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Cited by 187Cardiac Valve Diseases and TreatmentsAortic Disease and Treatment ApproachesInfective Endocarditis Diagnosis and Management

Effect of Tricuspid Regurgitation and the Right Heart on Survival After Transcatheter Aortic Valve Replacement: Insights From the Placement of Aortic Transcatheter Valves II Inoperable Cohort

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Lindman, Brian R., Maniar, Hersh S., Jaber, Wael A., Lerakis, Stamatios, Mack, Michael J., Suri, Rakesh M., Thourani, Vinod H., Babaliaros, Vasilis +9 more·2015·Circulation: Cardiovascular Interventions
DOI 10.1161/circinterventions.114.002073PMC PMC4438083
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Abstract

Background—: Tricuspid regurgitation (TR) and right ventricular (RV) dysfunction adversely affect outcomes in patients with heart failure or mitral valve disease, but their impact on outcomes in patients with aortic stenosis treated with transcatheter aortic valve replacement has not been well characterized. Methods and Results—: Among 542 patients with symptomatic aortic stenosis treated in the Placement of Aortic Transcatheter Valves (PARTNER) II trial (inoperable cohort) with a Sapien or Sapien XT valve via a transfemoral approach, baseline TR severity, right atrial and RV size and RV function were evaluated by echocardiography according to established guidelines. One-year mortality was 16.9%, 17.2%, 32.6%, and 61.1% for patients with no/trace (n=167), mild (n=205), moderate (n=117), and severe (n=18) TR, respectively ( P <0.001). Increasing severity of RV dysfunction as well as right atrial and RV enlargement were also associated with increased mortality ( P <0.001). After multivariable adjustment, severe TR (hazard ratio, 3.20; 95% confidence interval, 1.50–6.82; P =0.003) and moderate TR (hazard ratio, 1.60; 95% confidence interval, 1.02–2.52; P =0.042) remained associated with increased mortality as did right atrial and RV enlargement, but not RV dysfunction. There was an interaction between TR and mitral regurgitation severity ( P =0.04); the increased hazard of death associated with moderate/severe TR only occurred in those with no/trace/mild mitral regurgitation. Conclusions—: In inoperable patients treated with transcatheter aortic valve replacement, moderate or severe TR and right heart enlargement are independently associated with increased 1-year mortality; however, the association between moderate or severe TR and an increased hazard of death was only found in those with minimal mitral regurgitation at baseline. These findings may improve our assessment of anticipated benefit from transcatheter aortic valve replacement and support the need for future studies on TR and the right heart, including whether concomitant treatment of TR in operable but high-risk patients with aortic stenosis is warranted. Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01314313.

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  • In patients with considerable associated mitral or tricuspid regurgitation, it is unclear whether concomitant surgical repair at the time of aortic valve replacement improves clinical outcomes.

    “In patients with considerable associated mitral or tricuspid regurgitation, it is unclear whether concomitant surgical repair of the mitral or tricuspid valve at the time of AVR would improve clinical outcomes242;243.”

    From Calcific aortic stenosis (2016) · cites this paper as [243]

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Authors
Lindman, B. R., Maniar, H. S., Jaber, W. A., Lerakis, S., Mack, M. J., Suri, R. M., Thourani, V. H., Babaliaros, V., Kereiakes, D. J., Whisenant, B., Miller, D. C., Tuzcu, E. M., Svensson, L. G., Xu, K., Doshi, D., Leon, M. B., & Zajarias, A.
Affiliations
  • Intermountain Healthcare (US)
  • From the Washington University School of Medicine, St. Louis, MO (B.R.L., H.S.M., A.Z.); Cleveland Clinic Foundation, OH (W.A.J., E.M.T., L.G.S.); Emory University School of Medicine, Atlanta, GA (S.L., V.H.T., V.B.); Baylor Scott and White Health, Plano, TX (M.J.M.); Mayo Clinic, Rochester, MN (R.M.S.); The Christ Hospital Heart and Vascular Center/The Lindner Research Center, Cincinnati, OH (D.J.K.); Intermountain Heart Center, Murray, UT (B.W.); Stanford University School of Medicine, CA (D.C.M....
ORCID
Venue
Circulation: Cardiovascular Interventions
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2015-04
Volume
8
Issue
4
ISSN
  • 1941-7632 (ISSN-L)
  • 1941-7640
DOI
10.1161/circinterventions.114.002073
PMC
PMC4438083
OpenAlex
W2548290160
Cited by
187
References
28
Citations by year
2026: 6 · 2025: 14 · 2024: 13 · 2023: 10 · 2022: 17 · 2021: 21 · 2020: 22 · 2019: 20 · 2018: 23 · 2017: 24 · 2016: 15 · 2015: 2
FWCI
15.53
Type
journal article
Language
en
Open access
Locations
  • Circulation Cardiovascular Interventions (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Heart, Lung, and Blood Institute (R01HL067025, K23HL116660)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
  • Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
Keywords
tricuspid regurgitation, transcatheter aortic valve implantation, aortic stenosis, right ventricular dysfunction, right heart enlargement, right atrial enlargement, mortality, mitral regurgitation, inoperable patients, Sapien valve, right heart failure, transcatheter tricuspid valve
MeSH terms
Aged, Aged, 80 and over, Aortic Valve Stenosis, Echocardiography, Female, Follow-Up Studies, Humans, Male, Postoperative Complications, Tricuspid Valve Insufficiency, Cohort Studies, Survival Analysis, Treatment Outcome, Ventricular Dysfunction, Right, Transcatheter Aortic Valve Replacement

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