Residual Tricuspid Regurgitation Post-Mitral Valve Interventions: A Prognostic Concern

Prognostic Significance of Residual TR

A recent analysis highlights the negative impact of residual severe tricuspid regurgitation (TR) following mitral valve-in-valve (ViV) procedures. Patients with residual severe TR face significantly higher mortality risks, with a 3-year mortality rate of 39.4% compared to 27.7% in those with mild TR. This emphasizes the need for monitoring and possibly early intervention in this high-risk group.

Challenges in Managing Combined Mitral and Tricuspid Disease

Managing combined mitral regurgitation (MR) and TR presents a clinical challenge, especially in the era of transcatheter interventions. Unlike surgical approaches, where both valves are addressed simultaneously, transcatheter procedures typically focus on one valve at a time. This raises questions about how residual TR should be managed when MR is treated successfully.

Key Findings from the Study

• Baseline TR Severity: Severe TR at baseline was linked to the worst outcomes, with higher all-cause mortality compared to mild or moderate TR.
• Post-Procedural TR: Among patients with severe TR at baseline, 68.1% showed at least a one-grade improvement in TR after the mitral ViV procedure. However, those with persistent severe TR continued to face higher mortality risks.
• Predictors of Poor TR Improvement: Patients with atrial fibrillation/flutter or low left ventricular ejection fraction (LVEF < 35%) were less likely to experience TR improvement.

Long-Term Mortality Trends

Residual TR was found to significantly influence mortality:

• Patients with severe residual TR at 30 days had a 43.2% mortality rate at 3 years.
• Those who showed early improvement in TR or sustained mild/moderate TR had better outcomes, with a mortality rate as low as 23.1%.

Clinical Implications

The study raises important questions about whether residual TR should be treated following MR interventions. Current evidence from transcatheter TR repair trials suggests that while functional status improves, mortality reduction remains unproven.

Monitoring and Follow-Up Recommendations

Patients with severe residual TR should undergo close follow-up. Indicators such as atrial fibrillation or low baseline LVEF may predict lack of TR improvement. A 30-day post-procedure evaluation may serve as a critical window to identify those requiring further intervention.