Key result
Concomitant tricuspid valve annuloplasty during LVAD implantation did not significantly improve 12-month overall survival compared to LVAD implantation alone (75% vs 57.89%, p=0.452).
Why the study?
Does concomitant tricuspid valve repair during LVAD implantation improve survival and right ventricular reverse remodeling in patients with end-stage heart failure and moderate to severe tricuspid regurgitation?
Cohort (n=31)
No
Does concomitant tricuspid valve repair during LVAD implantation improve survival and right ventricular reverse remodeling in patients with end-stage heart failure and moderate to severe tricuspid regurgitation?
Answers are grounded in this paper and cite their sources.
Concomitant tricuspid valve annuloplasty during LVAD implantation in patients with moderate to severe tricuspid regurgitation significantly reduces right ventricular diameter but does not significantly improve 1-year survival or early postoperative mortality compared to LVAD implantation alone.
Background. In the end stage heart failure (HF) patients with moderate to severe tricuspid regurgitation (TR), the surgical decision for tricuspid valve (TV) repair during left ventricular assist device (LVAD) implantation surgery is not clear. Methods. We included 31 patient with end-stage heart failure and moderate to severe TVR (≥II degree) to our retrospective study analysis. 19 patients received TV annuloplasty during LVAD implantation (TVR+ group), whereas 12 patients didn’t (TVR- group). Demographic, clinical and echocardiographic parameters were assessed in both groups preoperatively and 1 month after surgery. Overall 12 months survival was analysed with Kaplan – Meier method and compared between groups. Results. Inhospital or 30 days mortality rate in TVR+ and TVR- groups was 21.1% and 8.3%, respectively (p=0.624). The overall survival rates up to 12 months did not differ between groups (75% vs 57.89%, p=0.452). TV regurgitation grade was reduced significantly after LVAD implantation with (p=0.001) and without TV repair (p=0.008). Dimensions of RV and right atrium decreased in TVR+ group (p<0.001). The size of RV did not change significantly in TVRgroup postoperatively, however, the diameter of right atrium reduced significantly in this group (p=0.01). Systolic and mean pulmonary artery pressures decreased significantly in both groups of patients. The indices of RV longitudinal function were reduced preoperatively and did not change after LVAD implantation with and without TV repair. Conclusions. Pulmonary artery pressures decreased in all patients after LVAD implantation, while the diameter of RV reduced significantly in patients after concomitant TV repair. Early postoperative mortality and 1 year survival rates did not differ between end stage heart failure patients after LVAD implantation with or without TV annuloplasty.
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Jakuška et al. (2018) conducted a cohort in End-stage heart failure with moderate to severe tricuspid regurgitation (n=31). Concomitant tricuspid valve annuloplasty vs. LVAD implantation without tricuspid valve annuloplasty was evaluated on Overall survival up to 12 months (p=0.452). Concomitant tricuspid valve annuloplasty during LVAD implantation did not significantly improve 12-month overall survival compared to LVAD implantation alone (75% vs 57.89%, p=0.452).
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