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Multicenter Study
. 2016 Jun;101(6):2168-74.
doi: 10.1016/j.athoracsur.2016.03.040. Epub 2016 Apr 30.

Limited Utility of Tricuspid Valve Repair at the Time of Left Ventricular Assist Device Implantation

Howard K Song  1 , Jill M Gelow  2 , James Mudd  2 , Christopher Chien  2 , Frederick A Tibayan  3 , Kathryn Hollifield  4 , David Naftel  4 , James Kirklin  4
Affiliations
Multicenter Study

Limited Utility of Tricuspid Valve Repair at the Time of Left Ventricular Assist Device Implantation

Howard K Song et al. Ann Thorac Surg. 2016 Jun.

Abstract

Background: The optimal management of tricuspid regurgitation (TR) in patients undergoing left ventricular assist device (LVAD) implantation is controversial. This study was undertaken to determine the impact of tricuspid valve repair (TVR) at the time of LVAD implantation on survival.

Methods: The Interagency Registry for Mechanically Assisted Circulatory Support was used to analyze the outcomes of patients undergoing LVAD implantation as destination therapy with or without concomitant TVR.

Results: Among 2,527 patients undergoing implant of a continuous flow LVAD as destination therapy during the study period, 989 (39%) had moderate or severe TR. The management of TR was not uniform among these patients. Patients with moderate and severe TR underwent TVR in 16.7% and 35.3% of cases, respectively. Moderate and severe TR at the time of LVAD implantation were associated with poorer survival over the entire follow-up period (p = 0.009). Interestingly, TVR at the time of LVAD implantation did not confer improved survival, even among patients with preimplant moderate or severe TR. A potential explanation for this finding is that patients with preimplant moderate or severe TR who underwent LVAD implant with concomitant TVR commonly experienced recurrent, late TR (21% to 27%).

Conclusions: Tricuspid valve repair is performed commonly at the time of LVAD implant despite the fact that it does not confer a clear survival benefit. For many patients, LVAD implant alone relieves preimplant TR as effectively as LVAD implant with TVR. Further study is necessary to determine what factors lead to recurrence of late TR in LVAD patients both with and without TVR.

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Figures

Figure 1
Figure 1
Competing outcomes of survival on LVAD support, death, transplantation, and myocardial recovery among the study population. LVAD, left ventricular assist device.
Figure 2
Figure 2
Survival of patients with none/mild vs. moderate/severe tricuspid regurgitation at the time of LVAD implant. LVAD, left ventricular assist device.
Figure 3
Figure 3
Survival of patients with moderate/severe tricuspid regurgitation at the time of LVAD implant who underwent concomitant tricuspid valve repair vs. no tricuspid procedure. LVAD, left ventricular assist device.
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