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Concomitant Tricuspid Valve Surgery During HeartMate 3 LVAD Implantation and Long-Term Outcomes: Insights From the

Gloria Färber1, Daniel Zimpfer2, Jens Garbade3

  • 1Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Würzburg 97080, Germany.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|March 23, 2026
PubMed

Insights

Tricuspid valve surgery during HeartMate 3 left ventricular assist device implantation did not impact five-year survival. However, it may improve functional capacity and right heart function in patients with moderate tricuspid regurgitation.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Mechanical Circulatory Support

Background:

  • HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation is a key therapy for advanced heart failure.
  • Tricuspid regurgitation (TR) is common in LVAD patients and its management is debated.
  • The ELEVATE registry provides real-world data on HM3 implantation outcomes.

Purpose of the Study:

  • To evaluate the impact of concomitant tricuspid valve surgery (TVS) during HM3 LVAD implantation on long-term survival and clinical outcomes.
  • To compare outcomes between HM3 patients who underwent TVS and those who did not, specifically in the context of at least mild tricuspid regurgitation.

Main Methods:

  • Analysis of 463 patients with at least mild TR undergoing primary HM3 LVAD implantation from the ELEVATE registry.
  • Comparison of outcomes between 70 patients who underwent concomitant TVS and a matched cohort of 67 patients who did not.
  • Assessment of five-year survival, functional capacity (6-minute walk distance), quality of life, end-organ function, and adverse events.

Main Results:

  • No significant differences in baseline demographics were observed between the TVS and no-TVS groups in the matched cohort.
  • Five-year survival rates were similar between patients with and without TVS (69.0% vs 59.3%).
  • Patients undergoing TVS showed a trend towards improved functional capacity and a significantly lower risk of right heart failure.

Conclusions:

  • Concomitant TVS during HM3 LVAD implantation does not adversely affect five-year survival.
  • TVS may offer benefits in terms of improved functional capacity and reduced right heart failure risk in selected patients.
  • Further research is warranted to optimize patient selection for TVS during LVAD procedures.
Abstract

Keywords:
HeartMate 3concomitant valve surgeryheart failureleft ventricular assist devicetricuspid valve regurgitation

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