Impact of concurrent tricuspid regurgitation on mortality after transcatheter aortic-valve implantation.

OBJECTIVES: To determine whether concomitant tricuspid regurgitation (TR) is associated with increased mortality in patients with severe aortic stenosis (AS) undergoing transcatheter aortic-valve implantation (TAVI), we performed a meta-analysis of currently available studies.

METHODS: MEDLINE and EMBASE were searched through May 2018. We included comparative or cohort studies enrolling patients with AS undergoing TAVI and reporting early (in-hospital or 30-day) and late (including early) all-cause mortality in patients stratified by baseline TR grade. An odds ratio (OR) of early mortality and a hazard ratio (HR) of late mortality with its 95% CI for significant versus non-significant (typically, ≥moderate versus <moderate) TR was extracted. Study-specific estimates were combined in the random-effects model.

RESULTS: Our search identified 12 eligible studies enrolling a total of 41,485 TAVI patients. The meta-analysis for early mortality combining 3 ORs demonstrated a significant 1.80-fold increase in mortality with significant TR (OR, 1.80; 95% CI, 1.01 to 3.19; P = 0.05). The primary meta-analysis for midterm (6-month to 30-month) mortality combining all the 12 HRs/ORs indicated a significant 1.96-fold increase in mortality (HR/OR, 1.96; 95% CI, 1.35 to 2.85; P = 0.0004). The secondary meta-analysis for midterm mortality combining 7 homogeneous HRs (adjusted HRs for ≥moderate versus <moderate TR) showed a significant 2.25-fold increase in mortality (HR, 2.25; 95% CI, 1.20-4.24; P = 0.01).

CONCLUSIONS: Concurrent significant (typically, ≥moderate) TR is associated with an approximately two-fold increase in both early and midterm all-cause mortality in patients with AS undergoing TAVI.