Abraham Bishoy, Suppah Mustafa, Farina Juan, Botros Michael, Fath Ayman, Kaldas Sara, Megaly Michael, Chao Chieh-Ju, Arsanjani Reza, Ayoub Chadi, Fortuin F David, Sweeney John, Pellikka Patricia, Nkomo Vuyisile, Alkhouli Mohamad, Holmes David, Badr Amr, Alsidawi Said
Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ; Division of Cardiology, Columbia University, Miami, FL.
Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ.
Am Heart J. 2025 Feb;280:79-88. doi: 10.1016/j.ahj.2024.11.003. Epub 2024 Nov 13.
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 1-year post-TAVR patients.
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.
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 = .283), in-hospital mortality (0 vs 1.08%, P = .450), or mortality at 1-year follow up (15.38% vs 14.09%, P = .794). At 5-year follow up, moderate/severe MR group had higher mortality (61.4% vs 49.5%, P = .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 = .54) or in-hospital mortality (0% vs 1.1%, P = .33). At 1-year follow up, patients with moderate or severe TR had higher mortality (26.7% vs 13.2%, P = .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 < .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 = .023) and at 5-year (OR 1.46, 95% CI [1.092, 1.952], P = .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.
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 multivalvular heart disease prior to the procedure is warranted.
三尖瓣反流（TR）和二尖瓣反流（MR）是经导管主动脉瓣置换术（TAVR）患者中常见的瓣膜疾病。这项回顾性研究调查了中度或重度TR和MR对TAVR术后1年患者全因死亡率的影响。
确定了2012年至2018年期间在我们医疗系统的3个学术三级医疗中心接受TAVR的连续患者。根据瓣膜反流严重程度将患者分为2组：中度/重度MR组与无/轻度MR组，以及中度/重度TR组与无/轻度TR组。主要结局是1年和5年随访时的全因死亡率，次要结局是住院死亡。进行逻辑回归分析以评估中度/重度MR或TR与1年和5年随访时全因死亡率之间的关系。
我们共纳入了1071例接受TAVR的患者，平均年龄80.9±8.6岁，97%为白人，58.3%为男性。中度或重度MR组包括52例（4.88%）患者，而轻度或无MR组包括1015例（95.12%）患者。两组在TAVR手术成功率（100%对97.83%，P = 0.283）、住院死亡率（0对1.08%，P = 0.450）或1年随访死亡率（15.38%对14.09%，P = 0.794）方面无显著差异。在5年随访时，中度/重度MR组的死亡率更高（61.4%对49.5%，P = 0.046）。在多变量逻辑回归分析中，中度或重度MR在1年和5年随访时与全因死亡率无显著相关性。中度或重度TR组包括86例（8.03%）患者，而轻度或无TR组包括985例（91.97%）患者。两组在TAVR手术成功率（98.8%对'97.9%，P = 0.54）或住院死亡率（0%对1.1%，P = 0.33）方面无差异。在1年随访时，中度或重度TR患者的死亡率高于轻度或无TR患者（26.7%对13.2%，P = 0.001）。在5年的延长随访中也有相同的发现（68.3%对48.7%，P < 0.001）。在多变量cox回归分析中，中度/重度TR与1年（OR 1.94，95%CI [01.09，3.44]，P = 0.023）和5年（OR 1.46，95%CI [1.092，1.952]，P = 0.011）随访时的全因死亡率较高相关。与单独的中度/重度瓣膜反流或轻度/无瓣膜反流相比，中度/重度MR和TR合并的患者在5年随访时的死亡率更高。
在长期随访中，中度/重度TR而非MR与接受TAVR患者的较高死亡率相关。中度/重度TR和MR合并的患者死亡率更差。术前仔细评估多瓣膜心脏病是必要的。
