Surgical treatment of tricuspid valve insufficiency promotes early reverse remodeling in patients with axial-flow left ventricular assist devices

Abstract

In patients with severe tricuspid regurgitation undergoing left ventricular assist device implantation, a concomitant tricuspid valve procedure effectively reduces tricuspid regurgitation and promotes reverse remodeling of the right ventricle.

Clinical Outcomes After Implantation of a Centrifugal Flow Left Ventricular Assist Device and Concurrent Cardiac Valve Procedures

“…Consistent with findings from other studies, concurrent valve procedures did not affect overall mortality or length of intensive care unit or hospital stay. 14,[17][18][19] This study shows no increased mortality for HVAD alone versus HVAD plus AVP. In contrast to our findings, Pal et al 9 previously noted significantly increased mortality in a group of 12 patients undergoing AVP during implantation of an axial-flow cf-LVAD.…”

“…10 Preliminary studies suggest that tricuspid valve repair at the time of LVAD implantation may improve early outcomes and reduce RHF. [11][12][13][14] However, John et al 8 demonstrated increased RHF for patients undergoing concurrent tricuspid valve procedures (TVP) versus LVAD alone. It is unclear whether the increased postoperative RHF relates to the severity of preimplant TR or the TVP itself.…”

Left ventricular vs. biventricular mechanical support: Decision making and strategies for avoidance of right heart failure after left ventricular assist device implantation

“…However, leaving greater than moderate TR can induce worsening of RV function and TR increase over time, with later need for surgical correction [74]. TVR performed simultaneously with LVAD implantation in patients with pre-operative RVF associated with TR ≥ grade 3 can promote RV reverse remodeling and spare them from a permanent BVAD [75,76].…”

Continuous flow left ventricular assist device implant significantly improves pulmonary hypertension, right ventricular contractility and tricuspid valve competence

“…But, there is disagreement as to whether it will be beneficial long term. 2,[22][23][24][25] The group at the Mayo Clinic, a highly experienced VAD center, has demonstrated beneficial right ventricular reverse remodeling associated with an elimination of tricuspid regurgitation, though a significant benefit from a functional standpoint was not demonstrated. 25 It should be noted that the patients who underwent tricuspid valve surgery in this study likely had significant TR hemodynamically based upon significantly elevated CVP values.…”

“…2,[22][23][24][25] The group at the Mayo Clinic, a highly experienced VAD center, has demonstrated beneficial right ventricular reverse remodeling associated with an elimination of tricuspid regurgitation, though a significant benefit from a functional standpoint was not demonstrated. 25 It should be noted that the patients who underwent tricuspid valve surgery in this study likely had significant TR hemodynamically based upon significantly elevated CVP values. In their experience evaluating stable patients who underwent HM II LVAD implant with or without concomitant tricuspid valve surgery, the Mayo clinic group has additionally published improved RV performance, LV unloading, and improved mitral regurgitation following LVAD implant based upon echocardiographic analysis three and six months postsurgery.…”