Concomitant tricuspid valve surgery during heartmate 3 LVAD implantation and long-term outcomes: Insights from the ELEVATE registry

OBJECTIVES To assess whether tricuspid valve surgery (TVS) during HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation affects long-term survival and outcomes. METHODS The ELEVATE registry enrolled 540 HM3 patients across 26 centres; 463 undergoing primary LVAD implantation and at least mild tricuspid regurgitation (TR) formed this analysis. Concomitant TVS was performed in 70 (15.1%) patients. Five-year outcomes (survival, functional capacity, end-organ function, adverse events) were compared with those with similar severity of TR not receiving TVS in both overall population (with TVS n = 70 vs without TVS n = 264) and matched groups (each group n = 67, primary analysis cohort). RESULTS In the matched cohort, baseline demographics of patients with or without TVS showed no differences in age (57.9 ± 10.8 vs 57.3 ± 10.0; p = 0.728), sex (male, 92.5% vs 94.0%; p = 1.000), preoperative short-term mechanical circulatory support rate (6.0% vs 9.0% p = 0.744), NYHA class and quality of life (QoL) score and end-organ function. Preoperatively, patients with TVS had shorter six-minute walk distances (6MWD; 58.0 ± 109.0 m vs 105.3 ± 154.0 m; p = 0.081). At 5 years, patients with TVS showed no differences in survival (69.0% vs 59.3%, p = 0.67), 6MWD (311.1 ± 129.5 m vs 295.6 ± 137.7 m, p = 0.758), QoL score, or end-organ function, while presented a lower risk of right heart failure (EPPY 0.038 vs 0.092, p = 0.03). CONCLUSIONS In the ELEVATE registry, concomitant TVS during HM3 implantation was not associated with differences in five-year survival; however, it may have a positive effect on functional capacity and right heart function. Clinical registration number NCT02497950