The implications of the effect of tricuspid regurgitation on mortality in transcatheter aortic valve implantation patients with a low ejection fraction

Abstract

Especially in the last decade, after studies showing noninferiority compared to surgical aortic valve replacement in the intermediaterisk group, most research on transcatheter aortic valve implantation (TAVI) has focused on the question of which method is superior in the low-risk group. At this stage, we have come across fewer publications in recent years about the high-risk group in which TAVI has taken its place in the guidelines. In fact, the experience in the world with this group provides an opportunity to analyze the results of the subgroups and to identify possible improvement targets. The article by Imamura et al., 1 published in this issue of the journal, is a good example of such analysis. The authors evaluated the 2-year cardiovascular mortality risk factors of 298 patients with post-TAVI left ventricular (LV) dysfunction from the Optimized CathEter vAlvular iNtervention-Transcatheter Aortic Valve Implantation (OCEAN-TAVI) database, a Japanese database of 2588 patients. One of the key findings is that moderate or severe tricuspid regurgitation increases 2-year mortality approximately threefold. Another important finding is that improvement in tricuspid regurgitation in the first year after the procedure tends to reduce the risk of 2-year mortality. The OCEAN-TAVI database is a prospectively generated multicenter database from Japan. A quick search of Pubmed lists more than 60 articles written using this database. The database includes two-thirds of TAVIs conducted in Japan during the period October 2013 to May 2017 when this study was conducted. 2 Again, in the