Tricuspid regurgitation after transcatheter mitral valve repair: Clinical course and impact on outcome

Abstract

Objectives: The aim of this study was to determine the course of tricuspid regurgitation (TR) after transcatheter mitral valve repair (TMVR), identify predictors for severe TR after TMVR and determine the association of severe TR after TMVR with outcome.

Background: TR is often present in patients with symptomatic mitral regurgitation (MR) and is associated with increased morbidity and mortality. The clinical course of TR after TMVR has not been clearly determined.

Methods: Patients that underwent TMVR between 2009 and 2017 were included. Clinical data were compared between patients with and without severe TR at 6 months after TMVR. Multivariate logistic regression analysis was performed to identify predictors for severe TR after TMVR. Survival analysis was done for both groups, using the Kaplan-Meier method.

Results: A total of 146 patients were included (mean age 76 years, 51% male, 79% New York Heart Association class ≥3 and 29% severe TR at baseline). Advanced age, atrial fibrillation (AF), right ventricular (RV) dysfunction, and limited procedural MR reduction were revealed as independent predictors for severe TR after TMVR. Survival of patients with severe TR after TMVR was 58% after 2 years compared to 82% for those with non, mild or moderate TR.

Conclusions: Severe TR after TMVR is common in patients at advanced age, those with AF, RV dysfunction and limited MR reduction during TMVR and is associated with impaired survival. As the associated parameters are indicators of longstanding MR, research investigating the benefits of earlier intervention in MR should be initiated.

Keywords: MitraClip; atrial fibrillation; mitral valve regurgitation; right ventricular dysfunction; tricuspid valve regurgitation.

FIGURE 1

Flowchart of patients eligible for study. TMVR, transcatheter mitral valve repair; TTE, transthoracic echocardiography

FIGURE 2

Course of tricuspid regurgitation after TMVR. TMVR, transcatheter mitral valve repair

FIGURE 3

NYHA class before and after TMVR compared between patients with severe TR and ≤ moderate TR at 6 months. NYHA, New York Heart Association; TMVR, transcatheter mitral valve repair, TR, tricuspid regurgitation

FIGURE 4

Survival after TMVR for patients with severe TR and less than severe TR at FU. FU, follow‐up; TMVR, transcatheter mitral valve repair; TR, tricuspid regurgitation; TTE, transthoracic echocardiography

FIGURE 5

Stages in the natural course of MR, showing development of AF, PH and RV dysfunction, with increasing prevalence of severe TR. AF, atrial fibrillation; MR, mitral regurgitation; PH, pulmonary hypertension; RV, right ventricle; TR, tricuspid regurgitation