Impact of Tricuspid Regurgitation (TR) on TAVR Outcomes
\nPublished: June 19, 2025
\nJournal of the American Heart Association
\nKey Findings:
\n1. Prevalence of TR in TAVR Patients:
\n\u2022 13.4% of over 2,000 TAVR patients had moderate or greater tricuspid regurgitation (TR) at the time of treatment.
\n2. Clinical Impact:
\n\u2022 Patients with moderate or greater TR showed:
\n\u2022 Higher risk of mortality and heart failure readmission.
\n\u2022 Increased need for permanent pacemaker implantation.
\n\u2022 More frequent paravalvular leaks and lower post-TAVR ejection fraction.
\n3. Survival Rates:
\n\u2022 1-year survival:
\n\u2022 < Moderate TR \u2192 96.6%
\n\u2022 \u2265 Moderate TR \u2192 93%
\n\u2022 5-year survival:
\n\u2022 < Moderate TR \u2192 59.1%
\n\u2022 \u2265 Moderate TR \u2192 43.1%
\n4. TR Progression Post-TAVR:
\n\u2022 8.1% of patients with initially mild TR developed new moderate\/severe TR within 1 year.
\n\u2022 62.1% of those with baseline moderate\/severe TR improved after TAVR.
\n5. Risk Factors for Developing TR After TAVR:
\n\u2022 Older age
\n\u2022 Female sex
\n\u2022 Peripheral artery disease
\n6. Clinical Implications:
\n\u2022 Significant TR is not just a marker of advanced aortic stenosis but an actionable comorbidity.
\n\u2022 Evidence supports concomitant tricuspid valve surgery during open-heart procedures, especially in the setting of left-sided valve disease.
\n\u2022 The study suggests the heart valve team should carefully consider whether to pursue double-valve surgery vs staged percutaneous approaches.
\n7. Limitations:
\n\u2022 Single-center study
\n\u2022 Long study duration during which TAVR techniques evolved<\/p>\n
Bottom Line:
\nIn 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.<\/p>\n