Abstract
BackgroundConcomitant tricuspid regurgitation (TR) is a common finding in mitral regurgitation (MR). Transcatheter repair (TMVR) is a favorable treatment option in patients at elevated surgical risk. To date, evidence on long-term prognosis and the prognostic impact of TR after TMVR is limited.MethodsLong-term survival data of patients undergoing isolated edge-to-edge repair from June 2010 to March 2018 (combinations with other forms of TMVR or tricuspid valve therapy excluded) were analyzed in a retrospective monocentric study. TR severity was categorized and the impact of TR on survival was analysed.ResultsOverall, 606 patients [46.5% female, 56.4% functional MR (FMR)] were enrolled in this study. TR at baseline was categorized severe/medium/mild/no or trace in 23.2/34.3/36.3/6.3% of the cases. At 30-day follow-up, improvement of at least one TR-grade was documented in 34.9%. Severe TR at baseline was identified as predictor of 1-year survival [65.2% vs. 77.0%, p = 0.030; HR for death 1.68 (95% CI 1.12–2.54), p = 0.013] and in FMR-patients also regarding long-term prognosis [adjusted HR for long-term mortality 1.57 (95% CI 1.00–2.45), p = 0.049]. Missing post-interventional reduction of TR severity was predictive for poor prognosis, especially in the FMR-subgroup [1-year survival: 92.9% vs. 78.3%, p = 0.025; HR for death at 1-year follow-up 3.31 (95% CI 1.15–9.58), p = 0.027]. While BNP levels decreased in both subgroups, TR reduction was associated with improved symptomatic benefit (NYHA-class-reduction 78.6 vs. 65.9%, p = 0.021).ConclusionIn this large study, both, severe TR at baseline as well as missing secondary reduction were predictive for impaired long-term prognosis, especially in patients with FMR etiology. TR reduction was associated with increased symptomatic benefit.Graphic abstract
Highlights
Mitral valve regurgitation (MR) is a common valvular disorder with an age-dependent prevalence exceeding 10% in individuals over 75 years [1]
Clinical Research in Cardiology (2021) 110:676–688. In this large study, both, severe tricuspid regurgitation (TR) at baseline as well as missing secondary reduction were predictive for impaired long-term prognosis, especially in patients with functional MR (FMR) etiology
TR reduction was associated with increased symptomatic benefit
Summary
Mitral valve regurgitation (MR) is a common valvular disorder with an age-dependent prevalence exceeding 10% in individuals over 75 years [1]. As many of these patients are at relevantly elevated surgical risk [2], percutaneous minimally invasive transcatheter mitral valve repair (TMVR) has become a frequently used treatment. Tricuspid valve regurgitation (TR) is a common finding in elder patients: the Framingham Heart Study reported on an incidence of moderate or severe TR in 5.6% of female and 1.5% of male individuals aged 70 years and older [3]. With the development of treatment devices dedicated to interventional tricuspid valve repair for patients at elevated surgical risk, the question of a prognostic impact of TR in patients with significant MR gains further relevance.
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