Late follow-up for a randomized trial of surgical treatment of tricuspid valve regurgitation in patients undergoing left ventricular assist device implantation

Michelle Mendiola Pla, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC. Electronic address: michelle.mendiola.pla@duke.edu.
Stuart D. Russell, Division of Cardiology, Duke University Medical Center, Durham, NC.
Carmelo A. Milano, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC.
Yuting Chiang, Advocate Health - MidwestFollow
Lillian Kang, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC.
Emily Poehlein, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC.
Cynthia L. Green, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC.
Frank Benedetti, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC.
Han Billard, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC.
Benjamin S. Bryner, Division of Cardiothoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Jacob N. Schroder, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC.
Mani A. Daneshmand, Division of Cardiothoracic Surgery, Emory University, Atlanta, GA.
Alina Nicoara, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
Adam D. DeVore, Division of Cardiology, Duke University Medical Center, Durham, NC.
Chetan B. Patel, Division of Cardiology, Duke University Medical Center, Durham, NC.
Muath Bishawi, Division of Cardiothoracic Surgery, Emory University, Atlanta, GA.

Affiliations

Aurora St. Luke's Medical Center

Abstract

Objectives:We previously reported that concurrent tricuspid valve surgery (TVS) was not associated with a lower incidence of early RHF among patients undergoing durable LVAD implantation. This is a follow-up analysis to further define the clinical impact of concurrent TVS within 12-months of follow-up.

Methods:Patients with moderate or severe TR on pre-operative echocardiography (n=71) were randomized to either LVAD implantation alone (No TVS, n=34) or with concurrent TVS (TVS, n=37). Randomization was stratified by pre-operative right ventricular dysfunction. Patients were followed for at least 12-months after surgery. The incidence of RHF was determined using INTERMACS criteria by an adjudication committee. Functional studies and repeat echocardiography were performed at 12-months.

Results:Demographics were similar between the two arms. At 12-months, the rate of moderate or severe RHF was 50.0% (No TVS) versus 51.4% (TVS). No patients developed RHF between 6- and 12-months following the procedure. Death from RHF was 5.4% (TVS) versus 8.8% (No TVS). At 12-months, there was no significant difference in TR severity between the two arms due to improvement in TR severity in the No TVS arm. On cardiopulmonary exercise testing at 12+ months, there was no significant difference in peak oxygen consumption.

Conclusions:In patients with significant pre-implant TR, the severity of TR improved over time in the LVAD implantation alone arm. By 12-months, there is no significant difference in TR severity between the two arms. This may account for the lack of difference in late clinical or functional parameters.

Document Type

Article

PubMed ID

39313112

Teammate Access


 

Share

COinS