Course and Clinical Impact of Tricuspid Regurgitation after LVAD Implantation: An Analysis of the EUROMACS Registry

Abstract

Purpose This study explores the course of uncorrected tricuspid regurgitation (TR) after left ventricular assist device (LVAD) implantation and the clinical impact of pre-LVAD TR on 30-day and late mortality. Methods The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) was used to identify adult patients undergoing LVAD implant with TR, but without concomitant tricuspid valve surgery. Multivariable regression models were used to assess the impact of TR on both early and late mortality. It was hypothesized that TR was associated with early mortality via well-known risk factors. Therefore, mediation analysis was conducted using structural equation models. Generalized mixed-models were used to model post-LVAD TR course over time. Results In total 2496 procedures were included. A higher pre-LVAD TR grade was associated with worse pre-LVAD right ventricular function (RVF) (OR 2,96 95%CI[2,18-4,01], p Conclusion Pre-LVAD TR is positively correlated with worse pre-LVAD RVF, and is associated with worse outcome. TR can decrease without intervention after LVAD implant. Therefore, patient selection for concomitant tricuspid valve surgery should not solely be based on TR grade.