Effect of Concomitant Tricuspid Valve Repair on Clinical and Echocardiographic Outcomes in Patients Undergoing Left Ventricular Assist Device Implantation

TL;DR

This study examines whether repairing the tricuspid valve during LVAD implantation improves outcomes for patients with significant tricuspid regurgitation.

Contribution

The study introduces new insights into the impact of tricuspid valve repair on right ventricular function and mortality in LVAD patients.

Findings

Tricuspid valve repair reduced postoperative tricuspid regurgitation severity but did not improve right ventricular strain or function.

Preoperative right ventricular deformation metrics predicted 2-year mortality better than pulmonary vascular resistance or pulsatility index.

Patients without tricuspid valve repair had better early discharge and lower 30-day readmission rates.

Abstract

Objectives: The purpose of this study was to determine whether concomitant tricuspid valve repair (TVr) at the time of left ventricular assist device (LVAD) implantation improves outcomes in patients with ≥moderate tricuspid regurgitation (TR) and to evaluate the prognostic value of preoperative right ventricular (RV) strain. Methods: In a retrospective analysis of 100 LVAD recipients (44 TVr; 56 No-TVr), preoperative (preop) and postoperative (postop) clinical, echocardiographic, and hemodynamic variables, including pulmonary vascular resistance (PVR) and pulmonary artery pulsatility index (PAPI), were analyzed. RV free wall strain (RV-FWS) and RV fractional area change (RV-FAC) were measured by speckle tracking. Early right heart failure (RHF) was modeled with multivariable logistic regression, and 2-year mortality was assessed with Fine–Gray competing risk regression. Preoperative and three-month measurements were compared within each of the 100 patients. Results: Baseline invasive hemodynamics, RV-FWS, and RV-FAC were similar between the TVr and No-TVr groups. TVr at the time of LVAD implantation reduced postoperative TR grade, but it did not improve RV-FWS or RV-FAC at 3 months. The No-TVr patients were more often discharged home and had lower 30-day readmissions. PVR was comparable preoperatively and at 3 months postoperatively. In adjusted analyses, preop PVR, PAPI, and TVr were not independently associated with early RHF, whereas decreased preoperative RV-FWS and lower preop RV-FAC independently predicted higher 2-year mortality. Conclusions: In LVAD recipients with ≥moderate TR, concomitant TVr lowers postoperative TR severity but does not improve early RHF, RV strain-based remodeling, or 2-year mortality. Preoperative RV deformation metrics, rather than preoperative PVR or PAPI, independently predict survival following LVAD implantation with or without TVr.

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