Durability of Tricuspid Valve Repair in Patients Undergoing Left Ventricular Assist Device Implantation

GND
128690275
ORCID
0000-0002-2153-2458
Affiliation
Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, 66421 Homburg/Saar, Germany
Färber, Gloria;
GND
1330834356
Affiliation
Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, 66421 Homburg/Saar, Germany
Schwan, Imke;
GND
1180648404
Affiliation
Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University Jena
Kirov, Hristo;
GND
1330838122
ORCID
0009-0005-8679-1804
Affiliation
Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University Jena
Rose, Marcel;
GND
1132620619
Affiliation
Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University Jena
Tkebuchava, Sophie;
GND
1205350969
Affiliation
Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, 66421 Homburg/Saar, Germany
Schneider, Ulrich;
GND
1242046895
Affiliation
Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University Jena
Caldonazo, Tulio;
ORCID
0000-0003-1529-6046
Affiliation
Department of Cardiac Surgery, Rotenburg Heart and Vascular Centre, 36199 Rotenburg an der Fulda, Germany
Diab, Mahmoud;
GND
120602571
ORCID
0000-0002-6411-909X
Affiliation
Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University Jena
Doenst, Torsten

Objectives: Benefits of tricuspid valve repair (TVR) in left ventricular assist device (LVAD) patients have been questioned. High TVR failure rates have been reported. Remaining or recurring TR was found to be a risk factor for right heart failure (RHF). Therefore, we assessed our experience.

Methods: Since 12/2010, 195 patients have undergone LVAD implantation in our center. Almost half (n = 94, 48%) received concomitant TVR (LVAD+TVR). These patients were included in our analysis. Echocardiographic and clinical data were assessed. Median follow-up was 2.8 years (7 days–0.6 years). Results were correlated with clinical outcomes. Results: LVAD+TVR patients were 59.8 ± 11.4 years old (89.4% male) and 37.3% were INTERMACS level 1 and 2. Preoperative TR was moderate in 28 and severe in 66 patients. RV function was severely impaired in 61 patients reflected by TAPSE-values of 11.2 ± 2.9 mm (vs. 15.7 ± 3.8 mm in n = 33; p < 0.001). Risk for RHF according to EUROMACS-RHF risk score was high (>4 points) in 60 patients, intermediate (>2–4 points) in 19 and low (0–2 points) in 15. RHF occurred in four patients (4.3%). Mean duration of echocardiographic follow-up was 2.8 ± 2.3 years. None of the patients presented with severe and only five (5.3%) with moderate TR. The vast majority (n = 63) had mild TR, and 26 patients had no/trace TR. Survival at 1, 3 and 5 years was 77.4%, 68.1% and 55.6%, 30-day mortality was 11.7% (n = 11). Heart transplantation was performed in 12 patients (12.8%). Conclusions: Contrary to expectations, concomitant TVR during LVAD implantation may result in excellent repair durability, which appears to be associated with low risk for RHF.

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