Predictors of Late Tricuspid Regurgitation in Patients with Left Ventricular Assist Devices

Abstract

Moderate and severe tricuspid regurgitation (TR) at the time of LVAD-Implantation is associated with poor survival. Therefore the benefit of Tricuspid repair at the time of LVAD implantation is subject of intensive discussion. The aim of this study was to evaluate predictors of moderate to severe and severe TR (ms-sTR) 6 months after Implantation. All patients that were able to present at our center 6 months after LVAD-Implantation underwent clinical assessment and echocardiography. We divided patients in two groups regarding postoperative TR (no to moderate TR vs. ms-sTR) and retrospectively analyzed preoperative-, operative data and the results of the 6 months follow up. 121 adult patients underwent LVAD-Implantation between 3/2018 and 2/2019. 51% were classified as INTERMACS profile 1 or 2. 31 patients died during first 6 months. Patients who were lost in follow up (n=4), with congenital heart disease (n=2) and patients who underwent Tricuspid repair (n=4) were excluded. Therefore 80 patients presented between 6.24 months (IQR: [5.8, 7.1]) supported with HeartWare HVAD 79 (n=63), HeartMate 3 (n=17). The patients were 56±11 years old, 68 were male, 12 female. 32 had dilative cardiomyopathy, 42 had ischemic cardiomyopathy, 6 other causes. All received optimal medical therapy (27 ACE-Inhibitor or angiogensine II receptor blockers, 51 Sacubitril-Valsartan, 69 aldosterone antagonist, 67 beta blockers). 10 patients showed late ms-sTR while 70 had no to moderate TR. There was no significant difference in preoperative clinical parameters (age, Body mass index, duration of heart failure, INTERMACS level, atrial fibrillation, implantable cardiovascular electric device) between the groups. There was also no significant difference in preoperative echocardiographic parameters (grade of TR, grade of mitral regurgitation, left ventricular enddiastolic diameter, left ventricular ejection fraction, right ventricular diameters, right ventricular ejection fraction, TAPSE, TK annulus diameter, systolic pulmonary artery pressure) between the two groups. 15 patients with preoperative ms-sTR showed spontaneous improvement and 7 patients with preoperative mild or moderate TR developed ms-sTR after six months. Late TR after LVAD-implantation may develop independent from preoperative right ventricular function and preoperative TR.