Impact of Tricuspid Valve Repair for Moderate Tricuspid Regurgitation at the Time of Left Ventricular Assist Device Implantation on the Occurrence of Right Heart Failure

PURPOSE: Significant tricuspid regurgitation (TR) in patients undergoing durable left ventricular assist device (LVAD) implantation has been associated with increased incidence of right heart failure (RHF). There is great surgical practice variability related to moderate TR repair at the time of LVAD implantation. In this single-center study, we investigated whether moderate TR repair concurrent with LVAD implantation has impact on late RHF occurrence. METHODS: We gathered data on adult patients undergoing durable LVAD implantation between 2009 and 2017. Only patients with moderate TR at the time of LVAD implantation constituted the study cohort. Patients were separated in two groups, concurrent tricuspid valve repair (TVr group) and no-TVr group. LateRHF was defined as any readmission for HF, requiring treatment with diuretics or inotropes or implantation of a right ventricular assist device. Unrepaired TR was categorized as improved if it was persistently graded as mild or less on post-operative echocardiographic studies. TVr failure was defined as moderate or severe TR on any post-operative echocardiographic study. Kaplan-Meier curves were used to analyze freedom from late RHF between the two groups. RESULTS: Out of 140 patients, 92 (65%) were in the TVr group. TVr failure was present in 35 (38%) of these patients. Out of the 48 patients in the no-TVr group, 22 (45%) experienced improvement of TR. Late RHF occurred in 12 (25%) patients in the no-TVr group and 35 (38%) patients in the TVr group. There was no event-free survival difference between the two groups (log rank p=0.678)(Figure). CONCLUSION: In our study cohort, we found no benefit in concurrent TVr for moderate TR at LVAD implantation on late RHF occurrence. Moreover, 45% of the patients with unrepaired moderate TR experienced improvement of TR, while 38% of patients with TVr experienced repair failure. Future randomized studies should address and confirm these results.

Duke Scholars

Author Carmelo Alessio Milano Surgery, Cardiovascular and Thoracic Surgery

Author Jacob Niall Schroder Surgery, Cardiovascular and Thoracic Surgery

Author Nazish Khalid Hashmi Anesthesiology, Cardiothoracic

Author Chetan B. Patel Medicine, Cardiology

Author Alina Nicoara Anesthesiology, Cardiothoracic