236Impact of tricuspid regurgitation on long-term survival in patients after percutaneous mitral valve repair

Abstract

Background: Functional tricuspid regurgitation (TR) is a common finding in patients with severe mitral regurgitation. Current guidelines recommend tricuspid valve repair in presence of TR ≥ II if patients undergo left-sided heart surgery since it is associated with worse survival and a high incidence of heart failure. While percutaneous mitral valve repair (PMVR) is on the advance, the role of concomitant TR remains unclear. Purpose: This study was aimed to investigate the impact of TR on long-term survival in patients after PMVR. Methods: We enrolled 175 consecutive patients with previous PMVR who presented during the years 2010 to 2016. TR grade was determined in transthoracic echocardiography according to current guidelines. Dichotomized groups (no/mild TR and moderate/severe TR) were analyzed using Cox regression model and Kaplan Meier estimator for survival analysis. Results: Among all patients 6 (3,4%) showed no, 97 (55,4%) mild, 55 (31,4%) moderate, and 17 (9,7%) severe TR. Patient characteristics are shown in table 1. Overall survival rate was 78,3% at one year, 50,3% at three years after PMVR. Proportional hazards model revealed NYHA class III and IV (HR 2,4; p=0,012 and HR 3,267; p=0,005), age (HR 1,06; p<0,001), and TR grade (HR 1,67; p=0,031) as independent predictors for mortality, also taking into consideration sex, pulmonary hypertension, chronic kidney disease, atrial fibrillation, coronary artery disease, arterial hypertension, and chronic obstructive pulmonary disease. TR grade ≥ II was associated with adverse outcome in Kaplan Meier analysis (overall all cause mortality), Log Rank, Chi square 8,18, p=0,004, see figure 1. NTproBNP levels were significantly higher in patients with TR ≥ II (Mdn 2596 pg/ml IQR 3375 vs. Mdn 4104 pg/ml IQR 7132; p=0,004). Conclusion: In patients with PMVR TR severity is associated with increased mortality. According to this study a coincident TR is an important modifier of patient survival after PMVR. New approaches for concomitant percutaneous treatment of TR should be pursued in the future.