Tricuspid Valve Repair in Patients with Left Ventricular Assist Device Implants and Tricuspid Valve Regurgitation: Propensity Score-Adjusted Analysis of Clinical Outcome

Abstract

OBJECTIVES: In end-stage heart failure patients with left-ventricular assist device implantation and tricuspid valve (TV) regurgitation grade >2, the surgical strategy for TV regurgitation is unclear at present. We aimed to compare clinical outcomes in patients receiving leftventricular assist device (LVAD) implants with or without TV repair (TVR). METHODS: We included 58 patients with TV regurgitation grade >2 in our data analysis. Thirty-two patients received TVR during LVAD implantation (TVR+ group), whereas 26 patients did not receive TVR (TVR− group). We assessed demographic and various preoperative clinical and echocardiographic parameters in both groups. The primary end-point was survival up to 1 year. Secondary end-points were the incidence of prolonged mechanical ventilatory support, rethoracotomy, early and late right heart failure and liver or kidney failure. RESULTS: Preoperatively, the two groups differed according to heart failure diagnosis, need for inotropic support and haemodynamic/ echocardiographic parameters such as transpulmonary gradient, cardiac index and the ratio of the right-ventricular end-diastolic diameter to the left-ventricular end-diastolic diameter. The survival rate up to 1 year was 53.1% in the TVR+ group and 73.1% in the TVR− group (P= 0.176). The propensity score (PS)-adjusted 1-year mortality risk with the TVR− group as a reference was 3.05 for the TVR+ group (95% confidence interval: 0.84–11.11; P= 0.091). Secondary end-points did not differ significantly between study groups. CONCLUSIONS: Data indicate that end-stage heart failure patients with TV regurgitation grade >2 undergoing LVAD implants do not benefit from concomitant TVR. Results have to be confirmed by prospective studies.