Efficacy of the Tricuspid Valve Intervention at the Time of Ventricular Assist Device Implantation

Purpose Tricuspid regurgitation (TR) is common in end-stage heart disease and is associated with an impaired survival after continuous flow left ventricular assist device (cf-LVAD) implantation. However, benefit of concomitant tricuspid valve surgery (TVS) at the time of cf-LVAD implantation is controversy. The aim of this study is to assess efficacy of TVS for patient's outcomes after cf-LVAD implantation. Methods We reviewed patients who underwent primary cf-VAD implantation between Jan 2011 and Apr 2019 in our institution. We assessed impact of TVS on post-operative survival and admission for heart failure (HF) using Kaplan-Meier curves and proportional hazards regression adjusted for age, gender, albumin, total bilirubin, INTERMACS profile and pre-operative tricuspid regurgitation. Results Out of consecutive 120 cf-VAD implantation, 62 patients were identified as TVS group, while 58 patients were identified as noTVS group. In the baseline characteristics, TVS group showed higher age (43.6 ± 12.1 vs 38.4 ± 13.4), frequent use of preop IABP (51.6% vs 25.9%, p Conclusion Although TVS group had significant risks (higher age, lower RVSWI, TR ≥ moderate) for HR, both groups showed equivalent survival and admission rate after cf-LVAD implantation, which indicated efficacy of tricuspid valve intervention for the population. Risk Hazard model might be biased because of low incidence of death and admission for HR in our cohort. Larger and longer study should be necessary to assess efficacy of TVS in such a country like Japan in which waiting period is much longer than the other countries.