# 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.

## Key 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.