Durability of DeVega Tricuspid Valve Annuloplasty for Severe Tricuspid Regurgitation at the Time of Continuous-Flow LVAD Implantation

Abstract

Purpose Functional tricuspid regurgitation (TR) is common in advanced heart failure patients who undergo LVAD implant. Recent studies suggest that tricuspid valve (TV) repair may have a positive impact on long-term right ventricular function and survival. The objective of this study is to evaluate the intermediate-term durability of DeVega TV annuloplasty (TVA) for severe TR when performed at the time of continuous-flow (CF) LVAD implant. Methods and Materials This is a retrospective study of 35 consecutive patients who underwent CF LVAD implant and DeVega TVA for severe TR and were alive at one year follow-up. Pre-operative, pre-discharge, and one year post-implant transthoracic echocardiograms were obtained for all patients. TR was graded as insignificant (none, trivial, or mild) or significant (moderate or severe). Results The HeartMate II LVAD was implanted in 30 patients and 5 underwent Heartware HVAD implant. Thirty-two of 35 (91.4%, Group A) improved from severe TR preoperatively to insignificant TR at the time of discharge following DeVega TVA and 3 (8.6%, Group B) had moderate residual TR. At one year follow-up, 29 of 32 (90.6%) in Group A had insignificant TR, 2 (6.3%) had moderate TR and 1 (3.1%) had severe TR. In Group B, 2 of 3 had no progression of their moderate TR at one year and 1 had severe TR. Overall, 2 of 35 (5.7%) had severe TR at one year following DeVega TVA and LVAD implant. Conclusions DeVega TVA appears to be an effective and durable repair for severe TR at the time of CF LVAD implant at one year follow-up. This technique requires less operative time than a formal annuloplasty ring and is also less costly. Although previous studies have shown that DeVega TVA for severe TR in conventional cardiac surgery may not be a durable procedure, unloading of the left ventricle and pulmonary circulation may contribute to the durability seen in this patient population.