Impact of Tricuspid Regurgitation (TR) on TAVR Outcomes
Impact of Tricuspid Regurgitation (TR) on TAVR Outcomes
Published: June 19, 2025
Journal of the American Heart Association
Key Findings:
1. Prevalence of TR in TAVR Patients:
• 13.4% of over 2,000 TAVR patients had moderate or greater tricuspid regurgitation (TR) at the time of treatment.
2. Clinical Impact:
• Patients with moderate or greater TR showed:
• Higher risk of mortality and heart failure readmission.
• Increased need for permanent pacemaker implantation.
• More frequent paravalvular leaks and lower post-TAVR ejection fraction.
3. Survival Rates:
• 1-year survival:
• < Moderate TR → 96.6%
• ≥ Moderate TR → 93%
• 5-year survival:
• < Moderate TR → 59.1%
• ≥ Moderate TR → 43.1%
4. TR Progression Post-TAVR:
• 8.1% of patients with initially mild TR developed new moderate/severe TR within 1 year.
• 62.1% of those with baseline moderate/severe TR improved after TAVR.
5. Risk Factors for Developing TR After TAVR:
• Older age
• Female sex
• Peripheral artery disease
6. Clinical Implications:
• Significant TR is not just a marker of advanced aortic stenosis but an actionable comorbidity.
• Evidence supports concomitant tricuspid valve surgery during open-heart procedures, especially in the setting of left-sided valve disease.
• The study suggests the heart valve team should carefully consider whether to pursue double-valve surgery vs staged percutaneous approaches.
7. Limitations:
• Single-center study
• Long study duration during which TAVR techniques evolved
Bottom Line:
In patients undergoing TAVR for severe aortic stenosis, moderate or greater tricuspid regurgitation is associated with worse outcomes. TR should be evaluated as a therapeutic target, not just a risk indicator, especially in valve team discussions and procedural planning.
https://www.ahajournals.org/doi/10.1161/JAHA.125.040955