Post-procedural tricuspid regurgitation predicts long-term survival in patients undergoing percutaneous mitral valve repair

Abstract

Background: Functional tricuspid regurgitation (TR) is frequently present in patients with severe mitral regurgitation and is associated with worse outcome. While percutaneous mitral valve repair (PMVR) is on the increase, the role of TR in those patients is unclear. This study aimed to compare pre- and post-procedural TR and investigated the impact of post-procedural TR and major clinical risk factors on long-term survival in patients undergoing PMVR.

Methods: In this retrospective observational cohort study, data from 213 consecutive patients at a tertiary care center undergoing PMVR from 2010 to 2016 were analyzed. Two different groups, dichotomized according to the degree of TR (none/mild and moderate/severe) were compared. Multivariable analyses were performed assessing predictors for long-term survival adjusting for major risk factors.

Results: Following PMVR TR was significantly reduced by at least 1 grade in 23.0% (p=0.001), while echocardiographic pulmonary pressure was decreased (TR Vmax 3.21±0.49m/s vs. 2.98±0.53m/s; p=<0.001). Patients with moderate or severe TR presented with worse New York Heart Association functional class and elevated N-terminal pro B-type natriuretic peptide levels compared to patients with none or mild TR. Median survival time was 1458 days. Proportional hazards model, adjusted for major risk factors, revealed post-procedural TR grade (HR 2.055, CI 1.317-3.206, p=0.02), severely impaired left ventricular function (HR 3.145, CI 1.199-8.250, p=0.020), and chronic kidney disease [glomerular filtration rate (GFR) 30-60ml/min HR 1.917, CI 1.109-3.314, p=0.020; GFR<30ml/min HR 3.969, CI 1.981-7.951, p<0.001] as independent predictors for long-term survival.

Conclusion: Post-procedural moderate and severe TR predicts worsened long-term survival in patients undergoing PMVR and is associated with adverse clinical outcome. Whether outcome might be improved by interventional reduction of post-procedural TR has to be investigated in the future.

Keywords: MitraClip; N-terminal pro B-type natriuretic peptide; Percutaneous mitral valve repair; Survival; Tricuspid regurgitation.