Baseline TR linked to lower quality of life after TAVR, M-TEER—are more interventions the answer?
Patients who present for transcatheter aortic valve replacement (TAVR) or mitral transcatheter edge-to-edge repair (M-TEER) with baseline moderate or severe tricuspid regurgitation (TR) are associated with lower quality-of-life (QOL) scores and worse clinical outcomes after treatment, according to new research published in JACC: Cardiovascular Interventions.[1]
“A more complete understanding of the association of TR with health status outcomes after TAVR and M-TEER is needed, particularly in light of evolving transcatheter tricuspid treatment options for TR,” wrote corresponding author Samir Kapadia, MD, an interventional cardiologist and chair of cardiovascular medicine at Cleveland Clinic, and colleagues.
Kapadia et al. tracked more than 130,000 patients who underwent isolated TAVR and more than 19,000 patients who underwent isolated M-TEER from January 2019 to June 2021. All data came from the Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy Registry.
The mean age of the TAVR group was 79.2 years old, 56.2% were men and the median STS risk score was 4.0. In the M-TEER group, meanwhile, the mean age was 76.9 years old, 54.4% were men and the median mitral valve STS risk score was 4.6.
While 84.6% of TAVR patients presented with no TR or mild TR at baseline, 13.1% had moderate TR and 2.3% had severe TR. Among M-TEER patients, 52.2% presented with no TR or mild TR at baseline, 33.2% had moderate TR and 14.7% had severe TR.
The authors noted that patients presenting for TAVR or M-TEER with higher levels of TR tended to be “significantly older and more complex with higher STS risk scores.” Procedural success rates were also much lower for these patients.
Diving into the data
Patients completed a 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline and then again after 30 days and one year to help specialists track physical limitations, symptoms, QOL and social limitations. Overall, mean KCCQ overall summary (OS) scores prior to TAVR were 39.4 for patients with severe TR, 45.2 for those with moderate TR and 51.3 for those with no or mild TR. Mean KCCQ-OS scores prior to M-TEER were 38.1 for patients with severe TR, 41.9 for those with moderate TR and 43.2 for those with no to mild TR.
One key takeaway from the group’s analysis was that patients with worse baseline TR actually saw bigger improvements in their KCCQ-OS scores than other patients. However, KCCQ-OS scores were still considerably lower after 30 days and one year for patients with no or mild TR prior to treatment than those with moderate or severe TR. After making certain adjustments, the group added, the difference in KCCQ-OS scores was no longer significant one year after M-TEER.
The group also evaluated QOL by tracking which patients were “alive and well” after one year, meaning patients with a one-year KCCQ-OS score higher than 60 and without a decrease of more 10 or more points from baseline.
Moderate and severe TR prior to treatment was linked to “significantly lower rates of being alive and well” one year after TAVR or M-TEER. Again, this changed slightly for M-TEER patients after researchers made multivariable adjustments—severe baseline TR was still linked to lower odds of being alive and well one year later, but the same was no longer true for moderate baseline TR.
When it came to clinical outcomes, meanwhile, the one-year risks of death were higher for patients with moderate or severe TR prior to TAVR or M-TEER than those with no or mild TR.
“Our findings highlight the negative impact of TR on health status and outcomes after TAVR and M-TEER,” the authors explained. “Hence, the incorporation of TR severity into risk prediction models before these procedures may be warranted.”
The group concluded by looking ahead. The next step of this research, they suggested, “would be to identify which group of patients would benefit from transcatheter tricuspid valve repair or replacement and determine the ideal timing for such interventions to optimize outcomes and health status.”
Read the full study in JACC: Cardiovascular Interventions, an American College of Cardiology journal, here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.