Prognostic Impact and Improvement of Mitral and Tricuspid Regurgitation in Patients Undergoing Transcatheter Aortic Valve Implantation: An Observational Study

Background: The prognostic significance of concomitant mitral regurgitation (MR) and tricuspid regurgitation (TR) in patients undergoing transcatheter aortic valve implantation (TAVI) remains unclear. Methods: In this single-center retrospective study, 183 patients who underwent successful TAVI between December 2012 and October 2021 were evaluated. Echocardiographic assessments were performed pre-procedurally, in the early (0–3 months) and late (>3 months) post-procedural periods. Patients were categorized according to MR and TR severity. The primary endpoint was a composite of all-cause mortality and hospitalization for heart failure. Results: Over a median follow-up of 2.26 years, 68 patients (37.2%) reached the primary endpoint. Event rates were higher in patients with moderate/severe MR (49.2%) and TR (45.1%) compared to those with no/mild regurgitation. However, adjusted analyses did not reveal a significant association between baseline MR or TR severity and the primary outcome. Improvement in MR was observed in 20.3% (early) and 38.8% (late), and in TR in 17.8% (early) and 30.9% (late) follow-up. Nevertheless, improvements in MR or TR severity were not significantly associated with survival. Beta-blocker use and left atrial dilation predicted MR improvement, whereas elevated tricuspid regurgitant velocity was a negative predictor for TR improvement. Conclusion: Baseline MR and TR severity were not independent predictors of adverse outcomes. Although regurgitation severity improved after TAVI, this did not affect survival. Thus, MR or TR should not be considered contraindications for TAVI.