Preoperative Moderate to Severe Tricuspid Regurgitation Does Not Affect Outcomes Following Placement of Continuous Flow LVADs

Abstract

Purpose In patients undergoing LVAD implantation, preoperative tricuspid valve (TV) regurgitation (TR) may lead to prolonged hospital stay, early mortality and post-operative RV dysfunction necessitating RVAD implantation. However, the impact of preoperative TR on postoperative morbidity and mortality is unknown, and the decision to operate for TR is controversial. Methods and Materials Between June 2005 and June 2012, 209 patients underwent implantation of continuous flow, implantable LVADs without concomitant TV repair. TR was Absent/Trivial or Mild in 57.9% (n=121, Group 1) and moderate/severe in 42.1% (n=88, Group 2). Outcomes were compared between groups using prospectively collected data from our institutional STS database. Results Heartmate II LVADs were placed in 76.1% of patients. Groups 1 and 2 had similar percentages of patients who received an LVAD as bridge to transplant (66.9% vs. 75.3%) and destination therapy (32.2% vs. 28.4%). Preoperative moderate to severe impairment of the RVEF was seen more commonly in Group 2 (43.3% vs. 62.7%, p=0.014), but this did not result in a higher rate of subsequent RVAD insertion (5.8% vs. 5.7%, p=1.00). No differences were seen with respect to either 30-day (6.6% vs. 10.2%, p=0.44) or overall (31.4% vs. 36.4%, p=0.46) mortality. Postoperative renal failure, ICU length of stay and hospital length of stay was similar in both groups as well. [ figure 1 ] Conclusions Preoperative evaluation of the severity of TR does not impact short term outcomes or RV morbidity and mortality, and it does not predict which patients would benefit from biventricular support. Further data regarding the long term effects of TR and the effect of TV repair or replacement are needed.