Ferrari Enrico, Pozzoli Alberto, Klersy Catherine, Caporali Elena, Demertzis Stefanos, Pedrazzini Giovanni
Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland.
Biomedical Faculty, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland.
J Cardiovasc Dev Dis. 2025 May 14;12(5):184. doi: 10.3390/jcdd12050184.
: The outcome of patients undergoing transcatheter aortic valve replacement (TAVR) can be affected by coexisting tricuspid regurgitation (TR). The aim of the study is to investigate the clinical results of patients undergoing TAVR with or without concomitant significant TR. : Patients undergoing TAVR were divided into two groups according to TR severity: none/mild TR (low-grade) and moderate/severe TR (significant). Data were analysed and compared. Primary endpoint was the mortality 1-year. Secondary endpoints were re-hospitalization and the degree of postoperative and 1-year TR. : TAVR procedures were performed in 345 patients between September 2011 and February 2020. Median STS score was 4.3% (IQR: 2.6-7.2), median LVEF was 59.0% (IQR: 45.0-62.0), median aortic area was 0.70cm (IQR: 0.60-0.86), median mean gradient was 43.0mmHg (IQR: 36.0-53.0). Before TAVR, 297 patients (86.1%) had low-grade TR and 48 (13.9%) significant TR. Mean age was 82.4 ± 5.7 and 83.8 ± 6.2 years in low-grade and significant TR group, respectively ( = 0.109), with 47.5% (low-grade TR) and 56.3% (significant TR) of female patients ( = 0.279). Patients showed differences in EuroSCORE-II (3.2% (IQR: 1.9-5.7) in low-grade TR vs. 5.6% (IQR: 3.7-8.1) in significant TR; < 0.001), impaired right ventricular function (3.0% vs. 20.8%; < 0.001) and pulmonary hypertension (9.1% vs. 39.6%; < 0.001). Mean valve size was 27.7 ± 2.9 mm. Hospital mortality was 2.0% in low-grade TR and 4.2% in significantTR patients ( = 0.308). Among discharged patients ( = 337), seven patients died within 30 days (2.0% low-grade TR; 2.1% significant TR; logrank test = 0.154) and 40 were re-hospitalized for heart failure (11.1% low-grade TR; 14.6% significant TR; = 0.470). After one year, 26 patients died, corresponding to a mortality of 7.9 deaths per 100-person year (95% CI 5.2-12.0) in low-grade TR group and 9.1 deaths per 100-person year (95% CI 3.4-24.3) in significant TR group (logrank test = 0.815), with HR (low grade vs. significant TR) of 0.87, 95% CI 0.26-2.89. Re-hospitalization for heart failure was 16.5% and 19.6% for low-grade and significant TR, respectively ( = 0.713). Echocardiographic and functional changes over time showed no significant interaction between TR and time. : In our experience, patients undergoing TAVR showed similar 30-day and 1-year outcome and re-hospitalization rate, regardless of the degree of concomitant tricuspid regurgitation.
接受经导管主动脉瓣置换术（TAVR）的患者的预后可能会受到并存的三尖瓣反流（TR）的影响。本研究的目的是调查接受或未伴有严重TR的TAVR患者的临床结果。
将接受TAVR的患者根据TR严重程度分为两组：无/轻度TR（低级别）和中度/重度TR（严重）。对数据进行分析和比较。主要终点是1年死亡率。次要终点是再次住院以及术后和1年时TR的程度。
2011年9月至2020年2月期间，对345例患者进行了TAVR手术。STS评分中位数为4.3%（四分位间距：2.6 - 7.2），左心室射血分数（LVEF）中位数为59.0%（四分位间距：45.0 - 62.0），主动脉瓣面积中位数为0.70cm²（四分位间距：0.60 - 0.86），平均压差中位数为43.0mmHg（四分位间距：36.0 - 53.0）。在TAVR之前，297例患者（86.1%）有低级别TR，48例（13.9%）有严重TR。低级别TR组和严重TR组的平均年龄分别为82.4±5.7岁和83.8±6.2岁（P = 0.109），女性患者分别占47.5%（低级别TR）和56.3%（严重TR）（P = 0.279）。患者在欧洲心脏手术风险评估系统（EuroSCORE）-II方面存在差异（低级别TR组为3.2%（四分位间距：1.9 - 5.7），严重TR组为5.6%（四分位间距：3.7 - 8.1）；P < 0.001），右心室功能受损（3.0%对20.8%；P < 0.001）和肺动脉高压（9.1%对39.6%；P < 0.001）。平均瓣膜尺寸为27.7±2.9mm。低级别TR患者的医院死亡率为2.0%，严重TR患者为4.2%（P = 0.308）。在出院患者中（n = 337），7例患者在30天内死亡（低级别TR组为2.0%；严重TR组为2.1%；对数秩检验P = 0.154），40例因心力衰竭再次住院（低级别TR组为11.1%；严重TR组为14.6%；P = 0.470）。1年后，26例患者死亡，低级别TR组每100人年死亡率为7.9例（95%可信区间5.2 - 12.0），严重TR组为每100人年9.1例（95%可信区间3.4 - 24.3）（对数秩检验P = 0.815），风险比（HR，低级别对严重TR）为0.87，95%可信区间0.26 - 2.89。低级别和严重TR组因心力衰竭再次住院的比例分别为16.5%和19.6%（P = 0.713）。随时间的超声心动图和功能变化显示TR与时间之间无显著相互作用。
根据我们的经验，接受TAVR的患者，无论并存三尖瓣反流的程度如何，其30天和1年的预后以及再次住院率相似。
