Effect of concomitant tricuspid valve surgery with left ventricular assist device implantation
Fujino T, Imamura T, Nitta D, et al. Effect of concomitant tricuspid valve surgery with left ventricular assist device implantation. Ann Thorac Surg. 2020;110(3):918-924.
© 2020 The Society of Thoracic Surgeons 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 after 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 before and after LVAD implantation. Moderate or greater TR was defined as significant.
Results: Among 199 consecutive patients, 194 had at least 2 echocardiographic TR assessments before and after LVAD implantation. Of these patients, 108 were included in the TVI-positive (TVI+) group and 86 in the TVI-negative (TVI–) group. In the TVI+ group, the prevalence of significant TR decreased from 52% to about 20% in the first 6 months after implantation (P < .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 = .028).
Conclusions: Concomitant TVI with LVAD implantation improved TR in most patients but did not have an impact on clinical outcomes. Significant postoperative TR after LVAD implantation, in patients with and without TVI, was associated with worse HF-free outcomes.