https://doi.org/10.1007/s00392-025-02625-4
1LMU Klinikum der Universität München Medizinische Klinik und Poliklinik I München, Deutschland; 2LMU Klinikum der Universität München Herzchirurgische Klinik und Poliklinik München, Deutschland
Aims:
This study aimed to assess the clinical impact of dual atrioventricular valve regurgitation (DAVR) on survival, symptomatic improvement, and echocardiographic outcomes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
Methods:
We retrospectively analyzed 3,491 consecutive patients who underwent transfemoral TAVR between January 2013 and December 2021. Baseline and follow-up mitral regurgitation (MR) and tricuspid regurgitation (TR) were assessed echocardiographically. DAVR was defined as the presence of both MR and TR ≥2+. Patients were divided into four groups based on echocardiography before TAVR: no/mild atrioventricular (AV) regurgitation, isolated MR≥2+, isolated TR≥2+, and DAVR.
Results:
DAVR was present in 269 patients (7.7%) and was associated with significantly reduced 3-year survival (47.3%) compared to isolated MR (64.3%), isolated TR (54.4%), and no/mild AV regurgitation (73.0%) (p<0.001). Multivariate analysis identified DAVR as an independent predictor of 3-year mortality (HR 1.36, 95% CI 1.1-1.8, p=0.021). A leading TR≥3+ in DAVR patients was associated with a particularly poor prognosis (3-year survival: 27%). MR improvement following TAVR was observed in 66.2% of DAVR patients and was linked to better survival (HR 0.45, 95% CI 0.30-0.69, p<0.001). In contrast, TR improvement occurred in 50.7% of patients but had no significant impact on survival (HR: 0.69, 95%CI: 0.45-1.05, p=0.086). Notably, 54% of DAVR patients continued to experience significant exertional dyspnea at follow-up (NYHA ≥II).
Conclusions:
The presence of DAVR in patients undergoing TAVR showed significantly lower 3-year survival compared to those with single or no additional valve regurgitation. Among DAVR patients, those with baseline TR≥3+ had the worst prognosis. Comprehensive pre-procedural echocardiographic assessment and targeted management are essential for improving outcomes in this high-risk population.