Early RHF post Tricuspid Valve Repair Performed Concurrent with LVAD Implantation is not associated with Late RHF

Surgical management of significant tricuspid regurgitation (TR) at the time of LVAD implantation is performed in an attempt to reduce the occurrence of postoperative right heart failure (RHF). RHF after LVAD implantation can occur early, defined as need for RVAD or inotropic support for more than 7 postoperative days, or late, defined as readmission for HF requiring inotropic or diuretic therapy. We sought to investigate the association between early RHF and late RHF in patients undergoing tricuspid valve repair (TVr) at the time of LVAD implantation.

We retrospectively reviewed a cohort of patients who underwent durable continuous flow LVAD and concurrent TVr between 2009-2017. Patients who died or were transplanted during the implant hospitalization were excluded. Clinical and demographic variables were compared between patients who developed late-RHF and those who did not using two sample tests. The Kaplan-Meier method was used to analyze freedom from late-RHF readmission associated with early-RHF. P

Out of 813 adult patients who underwent LVAD implantation, 146 underwent concurrent TVr and represented the study cohort. Out of these, 79 (54.1%) patients experienced early RHF and 53 (36.3%) patients experienced late RHF. The table summarizes selected clinical and demographic patient characteristcs. Out of the 79 patients that experienced early RHF, only 29 patients experienced also late RHF. There was no difference in the incidence of early RHF between patients who developed late-RHF and those who did not (54.7% vs 53.8%, p=0.525). There was no difference in freedom from late-RHF occurrence between patients who experienced early-RHF versus those who did not.

In our study cohort, early-RHF was not predictive of late-RHF. While further studies are required, it is likely that other factors play a stronger role in the development of late-RHF.