Clinical Outcomes and Prognosis among Patients with Tricuspid Regurgitation Undergoing Implantation of Left Ventricular Assist Devices

Background: Although implantation of a left ventricular assist device (LVAD) generally improves tricuspid regurgitation (TR) in short-term follow-up, the clinical significance of residual TR in patients with long-term LVAD support is undetermined.

Methods: A retrospective analysis of patients who underwent LVAD implantation at our institution between the years 2008-2017. Clinically significant TR was defined as ≥ moderate TR based on qualitative assessment. Median follow-up was 17 (IQR 5,31) months.

Results: Our cohort included 100 consecutive LVAD-supported patients of which 58 (58%) had pre-operative significant TR. Patients with pre-operative significant versus non-significant TR had elevated levels of gamma-glutamyltransferase (148 (IQR 70, 260) vs. 62 (IQR 26, 142), p=0.006), right atrial pressures (12 (IQR 6,14) mmHg vs. 8 (IQR 4,12) mmHg), p=0.051), but similar levels of right ventricular stroke work index (median 653 (IQR 482, 792)). During the first year after implantation TR severity diminished in 55% of patients with pre-operative significant TR. No differences were noted in the number of heart failure hospitalizations (mean 0.36±0.77 per patient) nor in the right atrial pressure measurements over 3 years of follow-up (median 7 (IQR 5,10) mmHg, p=0.490). During long-term follow-up mortality was similar among patients with pre-operative significant versus non-significant TR (67% vs. 61%, p=0.140).

Conclusions: Patients with pre-operative significant TR and normal right ventricular function do not demonstrate increased risk for heart failure hospitalizations and have similar survival compared to patients with pre-operative non-significant TR. These results challenge the clinical yield of concomitant tricuspid valve repair strategy during LVAD implantation. Larger-scale studies are needed.