Longitudinal Trend of Tricuspid Regurgitation Following Left Ventricular Assist Device Implantation

Abstract

Purpose Although tricuspid regurgitation (TR) following left ventricular assist device (LVAD) implantation is known to be related to unfavorable outcomes, the longitudinal trend of TR during LVAD course remains unknown. The aim of this study is to clarify the longitudinal trend of TR prior to and following LVAD implantation. Methods We retrospectively reviewed patients who received LVAD implantation between 4/2014-8/2018. We evaluated the grade of TR by echocardiography prior to and following LVAD implantation. TR grade was determined based on the color flow jet area. Moderate or severe TR was defined as significant. We compared clinical outcomes of patients with concomitant tricuspid valve (TV) procedure (TVP+) and those without (TVP-). Results Among 199 consecutive patients, 194 patients had at least 2 echocardiographic TR grade assessments. All patients had a test prior to LVAD implantation, and had an average of 6±4 tests after LVAD implantation during a median of 389 (range 8-1540) days of follow-up. Mean age was 57±13 years and 132 patients (68%) were male. 107 (55%) patients were included in TVP+. Prior to LVAD implantation the prevalence of significant TR was higher in TVP+ (51% in TVP+ vs 20% in TVP-, P All-cause mortality and heart failure (HF) readmission-free survival were similar between the groups. In contrast, patients with significant TR in the early period (within 6 months) had lower HF readmission-free survival (at 1 year, 60% in significant TR vs 74% in non-significant TR, P=0.015, Figure 1B). Conclusion Long-term trend of TR and clinical outcomes throughout LVAD course were similar between TVP+ and TVP-. Patients with significant TR had decreased HF-free survival.