BACKGROUND
Concomitant tricuspid regurgitation (TR) is common among patients with aortic stenosis
undergoing transcatheter aortic valve implantation (TAVI). Previous studies have reported
increased mortality rates in TAVI patients with persistent ≥moderate TR. The mechanisms
underlying atrial versus ventricular TR (A-TR, V-TR) have distinct pathophysiological
implications. However, the specific influence of A-TR versus V-TR on clinical outcomes after
TAVI remains unclear.
OBJECTIVES
The study aimed to compare clinical outcomes after TAVI between patients with severe
ventricular and atrial TR and to assess survival using Kaplan–Meier analysis.
METHODS
The study cohort included 2,908 consecutive patients undergoing TAVI between January
2015 and May 2023. Echocardiography was performed before discharge and at 30–90 days
post-procedure to determine the persistence of significant TR despite hemodynamic
changes after valve replacement. In patients with persistent severe TR and adequate image
quality, the mechanism was classified as ventricular or atrial according to right-sided
chamber morphology, annular geometry, and leaflet coaptation pattern. The primary
endpoint was one-year all-cause mortality following TAVI.
RESULTS
The mean age of the study population was 80.8±6.2 years, and 45.3% were female.
Concomitant ≥moderate TR was observed in 504 (17.3%) patients, of whom 21.0% had
severe TR. Among patients with severe TR, 17.5% were classified as V-TR and 37.5% as A-TR.
Notably, a substantial proportion (45%) showed overlapping atrial and ventricular features,
reflecting the advanced disease stage at which most TAVI candidates present. Compared
with A-TR, V-TR patients had larger right-ventricular and annular dimensions, higher systolic
and mean pulmonary pressures, and more frequent RV dysfunction (p<0.05). Overall,
≥moderate TR was associated with significantly higher one-year mortality rates as
compared to patients with no/mild TR (13.4% vs 6.8%, p<0.01). Kaplan–Meier analysis
revealed significantly higher one-year mortality in the V-TR group compared with the A-TR
group (p=0.05). The multivariable analysis identified V-TR as an independent predictor of
mortality in patients undergoing TAVI (HR: 1.47 [95% CI: 1.04 – 2.38], p=0.04).
CONCLUSIONS
Patients referred for TAVI with concomitant severe TR often represent an advanced disease
stage, making a clear distinction between atrial and ventricular phenotypes challenging.
Nonetheless, predominant ventricular-type TR is associated with adverse hemodynamic
profile and poorer survival, underscoring the importance of early recognition and
phenotype-specific management strategies.
