Impact of concomitant tricuspid regurgitation on long-term outcomes in severe aortic stenosis.
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Amano Masashi, Izumi Chisato, Taniguchi Tomohiko, Morimoto Takeshi, Miyake Makoto, Nishimura Shunsuke, Kitai Takeshi, Kato Takao, Kadota Kazushige, Ando Kenji, Furukawa Yutaka, Inada Tsukasa, Inoko Moriaki, Ishii Katsuhisa, Sakaguchi Genichi, Yamazaki Fumio, Koyama Tadaaki, Komiya Tatsuhiko, Yamanaka Kazuo, Nishiwaki Noboru, Kanemitsu Naoki, Saga Toshihiko, Ogawa Tatsuya, Nakayama Shogo, Tsuneyoshi Hiroshi, Iwakura Atsushi, Shiraga Kotaro, Hanyu Michiya, Ohno Nobuhisa, Fukumoto Atsushi, Yamada Tomoyuki, Nishizawa Junichiro, Esaki Jiro, Minatoya Kenji, Nakagawa Yoshihisa, Kimura Takeshi
Аннотация
METHODS AND RESULTS: In the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis (CURRENT AS) Registry enrolling 3815 consecutive patients with severe AS, there were 628 patients with moderate or severe TR (TR group) and 3187 patients with no or mild TR (no TR group). The study patients were subdivided into the initial aortic valve replacement (AVR) stratum (n = 1197) and the conservative stratum (n = 2618) according to treatment strategy. The primary outcome measure was a composite of aortic valve-related death or hospitalization due to heart failure. The 5-year freedom rate from the primary outcome measure was significantly lower in the TR group than in the no TR group (49.1% vs. 67.3%, P < 0.001). Even after adjusting for confounders, the excess risk of TR relative to no TR for the primary outcome measure remained significant [hazard ratio (HR): 1.25, 95% confidence interval (CI): 1.06-1.48; P = 0.008]. The trend for the excess adjusted risk in the TR group was consistent in the initial AVR and the conservative strata (HR 1.55, 95% CI: 0.97-2.48; P = 0.07; HR 1.22, 95% CI: 1.02-1.46; P = 0.03, respectively). In the initial AVR stratum, the 5-year freedom rate from the primary outcome measure was not different between the two groups with (n = 56) or without (n = 91) concomitant tricuspid annuloplasty (61.5% vs. 72.1%, P = 0.48).
CONCLUSION: The presence of clinically significant TR concomitant with severe AS is associated with a poor long-term outcome, regardless of the initial treatment strategy.