Concomitant Tricuspid Valve Repair in Patients Undergoing LVAD Placement Reduces Incidence of Acute Right Heart Failure

Abstract

<h3>Purpose</h3> Acute right heart failure following LVAD implantation continues to be a challenging post-operative problem. Although medical management can be helpful, biventricular support is sometimes required. There is much debate about whether tricuspid valve repair (TVR) should be performed in those patients with significant tricuspid valve regurgitation undergoing device implantation. <h3>Methods and Materials</h3> A total of 30 patients who underwent LVAD placement were included in the study. All had moderate to severe tricuspid regurgitation (TR) by pre-op 2D echocardiography. 21 of these patients received a TVR during HMII placement and 9 did not (control). Outcome measures were analyzed for age, survival, acute RVF, need for biventricular support, and other hemodynamic parameters. <h3>Results</h3> In the TVR group, central venous pressure (CVP) was significantly reduced pre- vs postop (17.3±4.2 vs 11.1±4.2 mmHg) than the control group (p≤0.01). Acute RVF was significantly lower in the TVR group, occurring in 1/21 patient (4.5%). In contrast, 3/9 (33%) patients who did not have repair had onset of RVF (p≤0.02). 2/9 patients in the control group required RVAD support, as compared 1/21 in the TVR group (p=0.08). The 30-day mortality rate was 28% lower in the TVR group compared to the control group (p=0.03) when assessed by Kaplan Meier curve. The event-free survival curve demonstrated a significant increase in survival in the TVR group (p=0.03). <h3>Conclusions</h3> Tricuspid valve regurgitation is a common finding at preoperative assessment for LVAD placement. If moderate to severe tricuspid valve regurgitation is observed, our experience suggests that concomitant TVR may reduce onset of acute RVF. [figure 1]