Long-term outcomes of tricuspid valve repair or replacement in patients with a continuous-flow left ventricular assist device

Abstract

Objective: To determine the long-term outcomes of concomitant tricuspid valve procedures (TVP) during continuous-flow left ventricular assist device (LVAD) implantation.

Methods: We retrospectively reviewed patients who received a HeartMate II or 3 LVAD between 2004 and 2023. Nine patients who had a previous TVP were excluded. Patients with a concurrent TVP were compared to those who received an LVAD alone using propensity score matching (PSM). The primary outcomes were survival, number of rehospitalizations, and long-term tricuspid regurgitation (TR).

Results: The study cohort comprised 727 patients, including 102 (14.0%) with a concomitant TVP (TVP group: 76 repairs, 26 replacements) and 625 (86.0%) without a TVP (No TVP group). PSM created 2 cohorts of 90 patients each. The median age of the matched cohorts was 59.0 years (interquartile range, 49.2-67.0 years). There were 144 males (80.0%), 172 patients (95.6%) who received LVAD as destination therapy, and 61 patients (33.9%) with ischemic cardiomyopathy. Within the first year after surgery, mortality was comparable in the 2 groups (adjusted hazard ratio [HR], 1.36; 95% confidence interval [CI], 0.63-2.90; P = .29). After the first year, the TVP group had a lower risk of mortality compared to the No TVP group (HR, 0.227; 95% CI, 0.082-0.633; P < .01). The 2 groups had a comparable risk of readmission (HR, 1.115; 95% CI, 0.777-1.601; P = .55). The TVP group had lower degrees of TR over time (P < .001).

Conclusions: Concomitant TVP with LVAD implantation was associated with reduced mortality and reduced grade of TR over an 8-year follow-up period, while readmissions were similar in comparable patients without TVP.

Keywords: concomitant valve repair; left ventricular assist device; tricuspid regurgitation; tricuspid valve repair.