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Tricuspid Valve Surgery in Patients Receiving Left Ventricular Assist Devices.
Hongtao Tie1,2, Rui Shi3, Henryk Welp1
1Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
The Thoracic and Cardiovascular Surgeon
|July 5, 2022
Summary
Concomitant tricuspid valve surgery during left ventricular assist device implantation did not improve outcomes and increased risks of right ventricular failure and renal replacement therapy. Further research is needed to clarify the role of tricuspid valve surgery in LVAD patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Mechanical Circulatory Support
Background:
- Tricuspid regurgitation (TR) is prevalent in patients undergoing left ventricular assist device (LVAD) implantation and is linked to poorer prognosis.
- The benefit of performing tricuspid valve surgery (TVS) concurrently with LVAD implantation remains uncertain, with conflicting evidence regarding short- and long-term outcomes.
Purpose of the Study:
- To investigate the impact of concomitant tricuspid valve surgery (TVS) on postoperative outcomes in patients with moderate-to-severe tricuspid regurgitation undergoing left ventricular assist device (LVAD) implantation.
- To evaluate the association between TVS and right ventricular failure (RVF), need for a right ventricular assist device (RVAD), hospital mortality, renal replacement therapy (RRT), and acute kidney injury (AKI).
Main Methods:
- A single-center, retrospective observational study included patients with moderate-to-severe TR who received LVADs between 2009 and 2020.
- Outcomes including postoperative RVF, RVAD use, hospital mortality, new-onset RRT, and AKI were assessed retrospectively.
- Survival analysis using Kaplan-Meier and competing-risk models was performed for long-term follow-up.
Main Results:
- Of 68 patients, 36 underwent concomitant TVS and 32 did not; baseline characteristics were similar.
- The TVS group showed significantly higher rates of postoperative RVF (52.8% vs. 25.0%), RVAD implantation (41.7% vs. 18.8%), and new-onset RRT (22.2% vs. 0%).
- No significant differences were observed in AKI incidence or hospital mortality; long-term survival was not improved by TVS.
Conclusions:
- Concomitant TVS in LVAD recipients with moderate-to-severe TR did not demonstrate survival benefits.
- TVS was associated with increased risks of postoperative RVF, RVAD support, and new-onset RRT.
- Given the small sample size and limited follow-up, further investigation is warranted to confirm these findings.
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