Pre- and postoperative tricuspid regurgitation in patients with severe symptomatic aortic stenosis: importance of pre-operative tricuspid annulus diameter.
Secondary tricuspid regurgitation (STR) is commonly found in patients with aortic stenosis and is associated with increased morbidity. The study sought to evaluate the prevalence of pre-operative STR and its progression after surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Also, it sought to analyse the predictors of post-operative changes in STR.



We prospectively evaluated 116 patients (aged 75.1 ± 9.8 years, predominantly male) who undergo SAVR or TAVI for severe aortic stenosis (AS) from September 2013 to April 2015. Patients with associated valve disease requiring intervention, significant coronary artery disease or left ventricular ejection fraction (LVEF) <50% were excluded. Clinical and echocardiographic data, including TR grade and right ventricular (RV) size and function, were assessed at baseline and at the 1-year follow-up. At baseline, significant TR was documented in 13 patients (11.1%) and non-significant TR was documented in 103 patients (88.9%). Atrial fibrillation (AF) was more prevalent in patients with a tricuspid annulus diameter ≥40 mm (P < 0.0051). At the 1-year follow-up, the TR grade had improved in 17 patients (14.7%), was unchanged in 68 patients (58.6%) and had worsened in 31 patients (26.7%). Moderate to severe TR was found in 30 patients (25.8%). Tricuspid annulus diameter >40 mm was the only echocardiographic predictor of significant postoperative TR (relative risk (RR) = 2.12 [1.26-3.54], P = 0.004). Right heart function and size were not independent predictors.



Significant TR was present pre-operatively in 11.1% of patients. Post-operative progression was observed in 26.7% of patients. Only tricuspid annulus size >40 mm was an independent echocardiographic predictor of moderate to severe TR at the 1-year follow-up.
CHU Rennes, Service de cardiologie et maladies vasculaires, CIC-IT 1414, 2 rue Henri Guilloux, 35000 Rennes, France.
Claire
C
Dumont
CHU Rennes, Service de cardiologie et maladies vasculaires, CIC-IT 1414, 2 rue Henri Guilloux, 35000 Rennes, France.|INSERM, U1099, 2 avenue du Pr Léon Bernard, CS 34317, 35000 Rennes, France.|Université de Rennes 1, LTSI, 2 avenue du Pr Léon Bernard, 35000 Rennes, France.
Elena
E
Galli
Pharmacologie Clinique et CIC-IP 1414, CHU Rennes et Université Rennes-1, 35000 Rennes, France.
Emmanuel
E
Oger
CHU Rennes, Service de cardiologie et maladies vasculaires, CIC-IT 1414, 2 rue Henri Guilloux, 35000 Rennes, France.
Maxime
M
Fournet
INSERM, U1099, 2 avenue du Pr Léon Bernard, CS 34317, 35000 Rennes, France.|Université de Rennes 1, LTSI, 2 avenue du Pr Léon Bernard, 35000 Rennes, France.|Cardiovascular and thoracic surgery department, CHU Rennes, 35000 France.
Erwan
E
Flecher
CHU Rennes, Service de cardiologie et maladies vasculaires, CIC-IT 1414, 2 rue Henri Guilloux, 35000 Rennes, France.|INSERM, U1099, 2 avenue du Pr Léon Bernard, CS 34317, 35000 Rennes, France.|Université de Rennes 1, LTSI, 2 avenue du Pr Léon Bernard, 35000 Rennes, France.
Christophe
C
Leclercq
INSERM, U1099, 2 avenue du Pr Léon Bernard, CS 34317, 35000 Rennes, France.|Université de Rennes 1, LTSI, 2 avenue du Pr Léon Bernard, 35000 Rennes, France.|Cardiovascular and thoracic surgery department, CHU Rennes, 35000 France.
Jean-Philippe
JP
Verhoye
CHU Rennes, Service de cardiologie et maladies vasculaires, CIC-IT 1414, 2 rue Henri Guilloux, 35000 Rennes, France.|INSERM, U1099, 2 avenue du Pr Léon Bernard, CS 34317, 35000 Rennes, France.|Université de Rennes 1, LTSI, 2 avenue du Pr Léon Bernard, 35000 Rennes, France.
Erwan
E
Donal
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000473:pathology; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology