Impact of tricuspid regurgitation and right ventricular dysfunction on outcomes after transcatheter aortic valve replacement: A systematic review and meta‐analysis

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 42; no. 1; pp. 206 - 212
• Main Authors: Fan, Jiaqi, Liu, Xianbao, Yu, Lei, Sun, Yinghao, Jaiswal, Sanjay, Zhu, Qifeng, Chen, Han, He, Yuxin, Wang, Lihan, Ren, Kaida, Wang, Jian'an
• Format: Journal Article
• Language: English
• Published: New York Wiley Periodicals, Inc 01-01-2019; John Wiley & Sons, Inc
• Subjects: all‐cause mortality; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - epidemiology; Aortic Valve Stenosis - surgery; Cardiovascular disease; Comorbidity; Coronary vessels; Echocardiography; Humans; Meta-analysis; Mortality; Prognosis; Review; Reviews; right ventricular function; Risk Factors; Severity of Illness Index; Systematic review; Transcatheter Aortic Valve Replacement; Treatment Outcome; tricuspid regurgitation; Tricuspid Valve Insufficiency - diagnosis; Tricuspid Valve Insufficiency - epidemiology; Tricuspid Valve Insufficiency - physiopathology; Ventricular Dysfunction, Right - diagnosis; Ventricular Dysfunction, Right - epidemiology; Ventricular Dysfunction, Right - physiopathology; Ventricular Function, Right - physiology; transcatheter aortic valve replacement; tricuspid regurgitation; prognosis; right ventricular function; all-cause mortality
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.23126

Far less attention has been paid to the prognostic effect of right‐side heart disease on outcomes after transcatheter aortic valve replacement (TAVR) when compared with the left side. Therefore, we performed a systematic review and meta‐analysis on the impact of tricuspid regurgitation (TR) and right ventricular (RV) dysfunction on outcomes after TAVR. We hypothesized that TR and RV dysfunction may have a deleterious effect on outcomes after TAVR. Article revealing the prognostic effect of TR and RV dysfunction on outcomes after TAVR were being integrated. Random or fixed effect model was adopted in accordance with the heterogeneity. There were nine studies with a total of 6466 patients enrolled after a comprehensive literature search of the MEDLINE/PubMed, EMBASE, ISI Web of Science, and Cochrane databases. The overall analysis revealed that moderate or severe TR at baseline increased all‐cause mortality after TAVR (HR = 1.79, CI 95% 1.52‐2.11, P < 0.001). Both baseline RV dysfunction (HR = 1.53, CI 95% 1.27‐1.83, P < 0.001) and presence of RV dilation (HR = 1.83, CI 95% 1.47‐2.27, P < 0.001) were associated with all‐cause mortality. Both baseline moderate or severe TR and RV dysfunction worsen prognosis after TAVR and careful assessment of right heart function should be done for clinical decision by the heart team before the TAVR procedure.