Results from a recent study published in the journal PLoS One showed that tricuspid regurgitation (TR), right ventricular (RV) function, age, and concomitant coronary artery bypass graft (CABG) are associated with outcome in patients undergoing aortic valve replacement (AVR) for severe aortic stenosis (AS).
The prognostic impact of tricuspid regurgitation (TR) in patients undergoing aortic valve replacement (AVR) for isolated severe aortic stenosis (AS) remains unclear, however recent evidence shows that there is an association between TR and clinical outcome.
TR has been found to be associated with a poor prognosis after mitral valve interventions like percutaneous balloon valvuloplasty or mitral valve repair and replacement.
Evidence has also shown that TR indicates a dismal prognosis in patients with tricuspid leaflet due to trauma, in heart failure patients, and in patients late after left heart valve surgery. However, in a previous study the researchers did not find an association of TR with mortality by multivariable analysis, while right ventricular (RV) systolic dysfunction was associated with outcome in patients, who previously underwent left heart valve surgery.
In the study titled “Prognostic Impact of Tricuspid Regurgitation in Patients Undergoing Aortic Valve Surgery for Aortic Stenosis,” the team of researchers led by Julia Mascherbauer from the Department of Cardiology, Medical University of Vienna, Vienna, Austria, assessed the predictive value of TR and/or RV systolic dysfunction prior to AVR in 465 AS patients.
The researchers used a computerized database to prospectively collect clinical, echocardiographic, operative and outcome data.
Results showed that at baseline, significant TR was present in 26 (5.6%) patients. Patients with TR presented with a higher EuroSCORE I, a higher incidence of previous cardiac surgery, pulmonary hypertension, more dilated RVs, and more frequent RV dysfunction.
Patients were followed for an average of 5.2 (±2.8 SD) years. Results from the multivariable analysis revealed that TR, RV dysfunction, age and concomitant coronary artery bypass graft surgery (CABG) were associated with overall mortality. The results also showed that survival rates were worse in patients with significant than with non-significant TR.
According to the researchers this finding underlines the importance of a thorough echocardiographic evaluation with particular consideration of the right heart in these patients.