Coexisting Moderate-to-Severe Tricuspid Regurgitation and Renal Dysfunction Identify a High-Risk Group After...

Moderate-to-severe tricuspid regurgitation (TR) and renal dysfunction are each associated with adverse outcomes after transcatheter aortic valve replacement (TAVR). We investigated whether their coexistence identifies a clinically relevant high-risk group.

In this retrospective two-centre cohort, patients undergoing TAVR were classified into four groups according to moderate-to-severe TR and preprocedural estimated glomerular filtration rate < 45 mL/min/1.73 m². The primary outcome was one-year all-cause mortality. Multivariable logistic regression adjusted for prespecified clinical covariates, and multiplicative interaction between TR and renal dysfunction was assessed.

Among 2227 patients, 1456 had neither condition, 324 isolated renal dysfunction, 315 isolated TR, and 132 both conditions. Patients with the combined phenotype had the highest rates of in-hospital mortality, 30-day mortality, acute kidney injury, and renal replacement therapy (all p < 0.001). One-year mortality increased progressively across groups (6.7%, 10.6%, 11.3%, and 22.9%; p < 0.001). After adjustment (n = 1704), the combined phenotype was associated with higher one-year mortality compared with neither condition (OR 2.91, 95% CI 1.62-5.23; p < 0.001), isolated TR (OR 2.17, 95% CI 1.16-4.07; p = 0.015), and isolated renal dysfunction (OR 2.32, 95% CI 1.16-4.61; p = 0.017). No significant multiplicative interaction was observed (p = 0.187).

Coexisting moderate-to-severe TR and renal dysfunction identify a clinically relevant high-risk group after TAVR, with higher adjusted one-year mortality than either condition alone. Combined assessment of TR and renal function may improve preprocedural risk stratification.