Impact of tricuspid regurgitation on late right ventricular failure in left ventricular assist device patients ~can prophylactic tricuspid annuloplasty prevent late right ventricular failure? ~

Abstract

Background In this study, we evaluated the prevalence of tricuspid regurgitation (TR) worsening in patients with left ventricular assist devices (LVADs) and its impact on late right ventricular (RV) failure. Methods We enrolled 147 patients of the 184 patients who underwent continuous-flow LVAD implantations from 2005 to March 2018. The prevalence of postoperative TR worsening and late RV failure were retrospectively evaluated. Results Concomitant tricuspid annuloplasty (TAP) was performed in 28 of 41 patients (68%) with preoperative TR greater than or equal to moderate (TR group) and in 23 of 106 patients (22%) with preoperative TR less than or equal to mild (non-TR group). Regarding the TR-free rates, despite receiving or not receiving concomitant TAP, there was no significant difference between the 2 groups (TR group: p = 0.37; non-TR group: p = 0.42). Of the 9 patients with postoperative TR greater than or equal to moderate, late RV failure developed in 3 patients, with TR worsening after RV failure in each case. During follow-up, 16 patients (11%) had late RV failure. As for the late RV failure-free rates, despite receiving or not receiving concomitant TAP, there was no significant difference between the 2 groups (TR group: p = 0.37; non-TR group: p = 0.96). Conclusions TR prognosis was preferable regardless of a patient receiving concomitant TAP; however, the presence of postoperative TR seemed to unrelated to late RV failure. Prophylactic TAP might not be necessary to prevent late RV failure.

Tricuspid Valve Surgery in Patients Receiving Left Ventricular Assist Devices

“…22 However, a recent study stated that late RV failure cannot be prevented by concomitant TVS. 9 Further, in unmatched patients of a study with 3,323 participants by Veen et al, 16 there were increased incidences of RVF and temporary RVAD support in patients with concomitant TVS compared with patients without this additional procedure. Besides, a significantly increased cumulative incidence of RVF during follow-up was observed.…”

“…6,7 The expected benefit of any concomitant tricuspid valve surgery (TVS) is based on the fact that (uncorrected) TR may aggravate the progress of the disease. 4,8,9 In a recent meta-analysis, though the pooled results failed to detect significant differences in interested outcomes, the authors concluded that concomitant TVS may benefit patients undergoing LVAD implantation since these patients had worse baseline characteristics. 10 Besides, current guidelines suggested considering concomitant TVS with LVAD implantation for moderate or worse regurgitation (classes of recommendations: IIb and levels of evidence: C).…”

Transcatheter valvular therapies in patients with left ventricular assist devices

“…However, this approach is still controversial and largely debated. Recent studies, including one randomized clinical trial-the TVVAD trial (NCT03775759) -, found that concurrent tricuspid valve repair at the time of LVAD implantation does not appear to lower the incidence of right heart failure (40)(41)(42).…”

Tricuspid surgery at the time of LVAD implant: A critique

“…While persistent MR after LVAD is a consistent marker of progressive RV failure ( 26 ), residual TR is not ( 27 ). In our experience the prevalence of significant residual MR after LVAD is similar between the groups with insignificant and significant TR, suggesting residual left sided failure is not the only etiology.…”

“…Intervention on the tricuspid valve at the time of LVAD has never demonstrated a survival advantage and concomitant TV procedures are associated with increased morbidity and mortality in a stratified analysis of the INTERMACS database ( 12 ). While concomitant TV surgery has been demonstrated to improve LVAD filling and hemodynamics ( 15 ), tricuspid annuloplasty does not impact the incidence or progression of late RV failure ( 27 ). Concomitant tricuspid surgery has a significant fail rate ( 14 ) and a small but persistent subset of patients (10–15%) without pre-operative TR develop TR over time ( 8 ).…”