IMPACT OF TRICUSPID VALVE INSUFFICIENCY ON THE PERFORMANCE OF THE LEFT VENTRICULAR ASSIST DEVICES

Abstract Objective We aimed to evaluate the impact of severe tricuspid valve insufficiency (TVI) at the time of left ventricular assist device (LVAD) implantation on the hemodynamic and LVAD parameters in an acute ovine model. Methods Stable heart failure (HF) was induced in 10 ovines through the application of 3 ± 1 coronary ligations. Once stable HF was obtained (after 15 ± 5 days), the animals were supported with an LVAD. Hemodynamic data and pump parameters were obtained and compared in two settings; first with LVAD in place after weaning from the cardiopulmonary bypass (CPB) machine (no TVI condition) and second following the induction of severe TVI through resection of the tricuspid valve (TVI condition). Results There were no statistically significant differences in the hemodynamic and pump parameters between TVI condition and no TVI conditions except for lower cardiac output in the TVI condition (2 (1.38-2.8) l/min vs. 3.2 (1.55-3.7), l/min, p=0.027) and the expected higher central venous pressure in the TVI condition (26 (24-31) mmHg vs. 15 (13-25) mmHg, p= 0.020). A median pump flow of 2.8 (2.45-3.75) l/min vs. 2.9 (2.75-3.8) l/min in the TVI condition and non-TVI condition was documented (p=0.160). Conclusion Results from this acute animal study suggest that severe TVI in HF with preserved RV function does not have significant impact on the LVAD pump parameters. The observed reduction in cardiac output may warrant further investigations, especially under loading conditions.