Background

Severe aortic stenosis (AS) and severe tricuspid regurgitation (TR) may coexist. The aim of this study was to determine the change in right ventricular (RV) function and TR after surgical aortic valve replacement combined with tricuspid valve repair (SAVR+TVr), transcatheter aortic valve replacement (TAVR), or conservative management and compare outcomes dependent on RV functional parameters and treatment allocation.

Methods

A retrospective analysis was conducted in 147 consecutive patients with severe AS and TR of baseline and 6-month clinical and echocardiographic parameters, including quantitative estimation of RV size and function (end-diastolic and end-systolic areas, tricuspid annular plane systolic excursion, fractional area change, and Tei index).

Results

SAVR+TVr and TAVR were associated with superior reduction in TR jet area after 6 months (P = .01 for time × group interaction) compared with conservative therapy. However, RV function (tricuspid annular plane systolic excursion and stroke volume) improved after TAVR but not after SAVR+TVr (P = .007 and P = .02 for time × group interaction, respectively). Conservative therapy for combined AS and TR was associated with >80% mortality in <4 years. TAVR and SAVR+TVr were associated with improved survival compared with conservative therapy (P < .0001), without significant difference between each other. Quantitative RV functional parameters were associated with poor outcomes, including tricuspid annular plane systolic excursion (P = .002), Tei index (P = .02), and RV fractional area change (P = .03).

Conclusions

In this nonrandomized, retrospective, observational study, SAVR+TVr and TAVR were associated with reductions in TR in patients with severe AS combined with severe TR. Importantly, RV function improved after TAVR but not after SAVR+TVr. Patients with severe AS and TR have a very poor prognosis with conservative therapy. When contemplating invasive procedures, assessment should include quantitative functional RV parameters.

中文翻译：

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严重三尖瓣关闭不全的主动脉瓣狭窄：保守经导管主动脉瓣置换术与外科主动脉瓣置换术联合三尖瓣修复术的比较研究

背景

严重的主动脉瓣狭窄（AS）和严重的三尖瓣关闭不全（TR）可能并存。这项研究的目的是确定外科主动脉瓣置换联合三尖瓣修复（SAVR + TVr），经导管主动脉瓣置换（TAVR）或保守治疗后右心室（RV）功能和TR的变化，并比较结局依赖性右室功能参数和治疗分配。

方法

回顾性分析了147例基线期严重AS和TR以及6个月临床和超声心动图参数的患者，包括RV大小和功能的定量估计（舒张末期和收缩末期，三尖瓣环平面收缩期偏移，分数面积变化和Tei指数）。

结果

 与保守治疗相比，SAVR + TVr和TAVR与6个月后TR射流面积的显着减少相关（时间=组相互作用P = 0.01）。但是，RV功能（三尖瓣环平面收缩期偏移和搏动量）在TAVR后有所改善，但在SAVR + TVr之后并未改善（ 对于时间×组相互作用，分别为P  = .007和P = .02）。在<4年内，合并AS和TR的保守治疗与> 80％的死亡率相关。与保守疗法相比，TAVR和SAVR + TVr与存活率提高相关（P  <.0001），彼此之间无显着差异。RV定量功能参数与不良结局相关，包括三尖瓣环平面收缩期偏移（P  = .002），Tei指数（P  = .02）和RV分数面积变化（P  = .03）。

结论

在这项非随机，回顾性观察性研究中，SAVR + TVr和TAVR与重度AS合并重度TR患者的TR降低相关。重要的是，RV功能在TAVR后有所改善，但在SAVR + TVr之后并未改善。患有严重AS和TR的患者采用保守疗法的预后很差。在考虑侵入性手术时，评估应包括定量的功能性RV参数。