Higher TR Severity Associated With Increased Mortality, Readmission in TAVR Patients

The risk of mortality and readmission in patients with tricuspid regurgitation (TR) who undergo TAVR may increase based on TR severity, according to a study published March 2 in the Annals of Thoracic Surgery.

Fenton H. McCarthy, MD, MS, et al., used the STS/ACC TVT Registry to evaluate the association between TR severity and TAVR outcomes in 34,576 patients who had TAVR between 2011 and 2015. Patients were stratified based on the degree of TR: none, mild, moderate or severe.

The study found a high prevalence of TR among patients undergoing TAVR, with more than 80 percent having at least mild TR and more than 24 percent having at least moderate TR. Of the 34,576 patients, 19.6 percent (6,772) had no TR, 56.1 percent (19,393) had mild TR, 19.3 percent (6,687) had moderate TR, and 5 percent (1,724) had severe TR.

The primary outcome of observed-to-expected in-hospital mortality ratio increased based on TR severity and peaked among those with severe TR. Overall in-hospital mortality was 4.5 percent, with the lowest rate in patients with mild TR (3.9 percent) and the highest rate in patients with severe TR (7.6 percent). In addition, patients with severe TR had the highest mortality rate at 30 days (11.3 percent), six months (26.8 percent) and one year (34.2 percent). Secondary outcomes of the length of intensive care unit and overall stays also increased incrementally based on TR severity.

The authors note that "there was a significant interaction between left ventricle ejection fraction (LVEF) and TR in that severe TR was independently associated with risk-adjusted increased mortality and heart failure readmission for patients with LVEF greater than 30 percent." They add that future research should investigate whether these patients would have better outcomes with surgical aortic valve replacement.

McCarthy et al., conclude that the effectiveness of TAVR in patients with aortic stenosis and severe TR warrants further research, particularly for lower-risk patients.

Keywords: Aortic Valve, Hospital Mortality, Thoracic Surgery, Transcatheter Aortic Valve Replacement, Heart Ventricles, Aortic Valve Stenosis, Heart Valve Prosthesis, Ventricular Function, Left, Heart Failure, Intensive Care Units, Registries, National Cardiovascular Data Registries

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