Effect of Concomitant Tricuspid Valve Surgery with Left Ventricular Assist Device Implantation

Abstract

Background

Tricuspid regurgitation (TR) is common in advanced heart failure (HF) patients. However, the effect of concomitant tricuspid valve repair or replacement (tricuspid valve intervention, TVI) with left ventricular assist device (LVAD) implantation is controversial. The aim of this study was to investigate the longitudinal trend of TR following LVAD implantation, and the effect of TVI on the TR trend and clinical outcomes.

Methods

We retrospectively reviewed patients at our institution who underwent LVAD implantation between April 2014 and August 2018. We evaluated the grade of TR by echocardiography prior to and following LVAD implantation. Moderate or greater TR was defined as significant.

Results

Among 199 consecutive patients, 194 patients had at least 2 echocardiographic TR assessments prior to and following LVAD implantation. Of these, 108 patients were included in the TVI+ group and 86 in the TVI− group. In the TVI+ group, the prevalence of significant TR decreased from 52% to about 20% in the first 6 months following implantation (P<0.01). Overall survival and HF readmission-free survival were comparable between the TVI+ and TVI− patients. In contrast, patients in both groups who had significant postoperative TR during early follow-up had worse 2-year HF readmission-free survival (36% in patients with significant postoperative TR vs 55% in those without significant postoperative TR, P=0.028).

Conclusions

Concomitant TVI with LVAD implantation improved TR in most patients, but did not have an impact on clinical outcomes. Significant postoperative TR following LVAD implantation, in patients with and without TVI, was associated with worse HF-free outcomes.