Author + information
- Received January 22, 2018
- Revision received March 8, 2018
- Accepted March 13, 2018
- Published online June 18, 2018.
- Janarthanan Sathananthan, MBChB, MPHa,
- Dale J. Murdoch, MBBSa,
- Brian R. Lindman, MD, MScib,
- Alan Zajarias, MDc,
- Wael A. Jaber, MDd,
- Paul Cremer, MDd,
- David Wood, MDa,
- Robert Moss, MDa,
- Anson Cheung, MDa,
- Jian Ye, MDa,
- Rebecca T. Hahn, MDe,
- Aaron Crowley, MAf,
- Martin B. Leon, MDe,f,
- Michael J. Mack, MDg and
- John G. Webb, MDa,∗ ()
- aCentre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, University of British Columbia, Vancouver, British Columbia, Canada
- bVanderbilt University Medical Center, Nashville, Tennessee
- cWashington University, St. Louis, Missouri
- dCleveland Clinic, Cleveland, Ohio
- eColumbia University Medical Center, New York, New York
- fCardiovascular Research Foundation, New York, New York
- gBaylor Scott & White Health, Plano, Texas
- ↵∗Address for correspondence:
Dr. John Webb, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
Objectives The aim of this study was to assess the implications of concomitant tricuspid regurgitation (TR) in patients undergoing valve-in-valve (VIV) transcatheter aortic valve replacement.
Background Patients undergoing VIV transcatheter aortic valve replacement with concomitant TR may have worse outcomes, and optimal management remains undetermined.
Methods The multicenter PARTNER 2 (Placement of Aortic Transcatheter Valves) VIV trial enrolled patients with symptomatic degenerated surgical aortic bioprostheses who were at high risk for reoperation. Outcomes were assessed between patients with mild or no TR versus moderate or severe TR.
Results A total of 237 patients underwent VIV procedures (mean age 78.7 ± 10.8 years, mean Society of Thoracic Surgeons score 9.1 ± 4.8%). In this cohort, 162 patients (68.4%) had mild or no TR, and 75 patients (31.6%) had moderate or severe TR. Although there was no difference in New York Heart Association functional class III or IV symptomatic status (89.3% vs. 91.4%; p = 0.62) or moderate or severe right ventricular dysfunction (9.4% vs. 16.9%; p = 0.11), patients with moderate or severe TR were more likely to be at high surgical risk, with a Society of Thoracic Surgeons score of >8 (62.7% vs 46.9%; p = 0.02). There was no difference in a composite endpoint of death and rehospitalization between moderate or severe TR and mild or no TR, either at 30 days (10.7% vs. 9.9%; p = 0.85) or at 1-year follow-up (24.1% vs. 23.2%; p = 0.80). There was a significant reduction in overall moderate or severe TR from baseline at 30 days (31.1% vs. 21.1%; p = 0.002), which was sustained at 1-year follow-up (38.0% vs. 22.8%; p = 0.004).
Conclusions Despite higher predicted surgical risk, the presence of TR was not a predictor of long-term outcomes. Importantly, there was significant reduction in TR severity at both short- and long-term follow-up. In selected patients undergoing VIV transcatheter aortic valve replacement, it may be appropriate to conservatively manage concomitant TR.
The PARTNER 2 trial was funded by Edwards Lifesciences. Dr. Sathananthan was supported by a grant from the National Heart Foundation of New Zealand. Dr. Lindman has received grant funding from Edwards Lifesciences and Roche Diagnostics; and consulting fees from Medtronic. Dr. Zajarias has received consulting fees from Edwards Lifesciences. Drs. Jaber and Hahn have echocardiographic core laboratory contracts with Edwards Lifesciences (no direct compensation). Dr. Wood is a consultant to Edwards Lifesciences. Drs. Leon, Mack, and Webb are members of the PARTNER Trial Executive Committee (no direct compensation). Dr. Webb is a consultant for Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 22, 2018.
- Revision received March 8, 2018.
- Accepted March 13, 2018.
- 2018 American College of Cardiology Foundation
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