Goel Kashish, Lindenfeld JoAnn, Yadav Pradeep, Hahn Rebecca T, Guerrero Mayra E, Chadderdon Scott, Sharma Rahul P, Smith Robert, Thourani Vinod, Eleid Mackram F, Davidson Charles J, Barker Colin, Kodali Susheel, Zahr Firas
Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Vanderbilt University Medical Center, Nashville, Tennessee, USA.
JACC Cardiovasc Interv. 2025 Jun 9;18(11):1438-1449. doi: 10.1016/j.jcin.2025.04.034.
There is a paucity of data on the impact of transcatheter mitral valve interventions on tricuspid regurgitation (TR).
This study aimed to assess the impact of preprocedural TR, residual TR at 30 days, and the associated change in TR severity after transseptal mitral valve-in-valve (MViV) replacement on 3-year mortality.
The Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry was used to extract data for all patients (n = 5,971) undergoing MViV from 2015 to 2024 at 513 sites. Propensity score matching was used to compare the impact of severe or greater TR on 3-year all-cause mortality.
Of the 4,938 patients who met the inclusion criteria, 1,039 (21.0%) had severe or greater TR at baseline. Preprocedural severe or greater TR was associated with significantly higher 3-year mortality compared with moderate and mild or less TR (39.4% vs 31.3% vs 27.7%; P = 0.004). Among patients with severe or greater TR, at least 1-grade improvement was noted in 68.1% at 30 days after MViV. In the 30-day landmark analysis, 3-year mortality was significantly higher in the group with residual severe or greater TR compared with moderate or less TR (43.2% vs 30.7%; P = 0.04). Improvement in TR grade from baseline to 30 days was associated with lower mortality compared with unchanged or worsened TR.
Preprocedural severe or greater TR, 30-day residual severe or greater TR, and unchanged or worsened TR after transseptal MViV were associated with a significantly increased risk for 3-year all-cause mortality. These findings underscore the negative impact of severe TR in multivalvular disease and identify a high-risk group for early intervention with transcatheter tricuspid therapies.
关于经导管二尖瓣干预对三尖瓣反流（TR）影响的数据匮乏。
本研究旨在评估经房间隔二尖瓣瓣中瓣（MViV）置换术前TR、30天时的残余TR以及TR严重程度的相关变化对3年死亡率的影响。
利用胸外科医师协会/美国心脏病学会经导管瓣膜治疗（TVT）注册中心的数据，提取2015年至2024年在513个地点接受MViV的所有患者（n = 5971）的数据。采用倾向评分匹配法比较重度或更严重TR对3年全因死亡率的影响。
在符合纳入标准的4938例患者中，1039例（21.0%）基线时存在重度或更严重TR。与中度、轻度或更低程度TR相比，术前重度或更严重TR与显著更高的3年死亡率相关（39.4%对31.3%对27.7%；P = 0.004）。在重度或更严重TR的患者中，MViV术后30天时68.1%的患者TR至少改善1级。在30天的标志性分析中，与中度或更低程度TR相比，残余重度或更严重TR组的3年死亡率显著更高（43.2%对30.7%；P = 0.04）。与TR无变化或恶化相比，从基线到30天TR分级的改善与更低的死亡率相关。
经房间隔MViV术前重度或更严重TR、30天残余重度或更严重TR以及TR无变化或恶化与3年全因死亡率风险显著增加相关。这些发现强调了重度TR在多瓣膜疾病中的负面影响，并确定了经导管三尖瓣治疗早期干预的高危人群。
