Abstract 13782: Tricuspid Regurgitation has Marked Prognostic Impact on Transcatheter Aortic Valve Replacement

Introduction: Transcatheter aortic valve replacement (TAVR) is an alternative to surgical valve replacement in severe aortic stenosis. Although tricuspid regurgitation (TR) has prognostic impact in surgical aortic valve replacement, its impact in TAVR procedures is unknown. We examined the effect of TR in TAVR patients. Methods: TR was examined in 129 patients with prior TAVR. TR was assessed pre- and 30-days post procedure, and classified as none, mild, moderate or severe. Significant TR was defined as greater than mild, and worsened TR (30 days post TAVR) defined as increase of ≥1 grade over baseline. Late TR was > mild at 30 follow-up compared to baseline. Results: Mean patient age was 84±8 years, and 46% were female, and had severe aortic stenosis (mean gradient 43.7±13.7mmHg, mean valve area 0.7±0.2 cm2). Significant TR occurred in 32 cases (26.4%) at baseline. Cases were divided into 2 TR groups, none (n=89) and significant (n=32). Left ventricular EF did not differ at either timepoint for the no-TR and significant TR groups. All-cause death among no-TR and significant TR patients was 12 (13.5%) and 11 (34.4%), respectively (p<0.005). TR worsened in 17 cases (14.0%) at 30-day follow up. Multivariate analysis showed that predictors of worsening TR were body mass index (OR 0.8, 95% CI 0.71-0.96 p=0.01), paravalvular leak (OR 6.5, 95% CI 1.7-24.4 p=0.0061) and atrial fibrillation (OR 5.4, 95% CI 1.36-21.73, p=0.017). Late TR occurred in 26 cases (23.6%), and predictors were paravalvular leak, BMI, and atrial fibrillation. Kaplan-Meier analysis showed survival was significantly worse both in patients with significant TR and in patients developing late TR (p=0.01). Conclusions: TR presence and severity, either at baseline or late, is associated with increased mortality/worse survival, independent of baseline left ventricular ejection fraction. Whether this is cause and effect or only a marker for adverse cardiac function should be established. TR status and severity should be included in transcatheter aortic valve replacement risk assessment.