Natural History and Prognosis of Patients with Unrepaired Tricuspid Regurgitation Undergoing Implantation of Left Ventricular Assist Device. Issue 4 (8th July 2021)

• Record Type: Journal Article
• Authors: Itzhaki Ben Zadok, Osnat; Ben-Avraham, Binyamin; Barac, Yaron D.; Hammer, Yoav; Rubachevski, Victor; Shaul, Aviv; Vaturi, Mordehay; Mats, Israel; Arnavitzki, Rosana; Aravot, Dan; Kornowski, Ran; Ben Gal, Tuvia
• Is Part Of: ASAIO journal. Volume 68:Issue 4(2022)
• Page Start: 508
• Page End: 515
• Publication Date: 2021-07-08
• Subjects: tricuspid regurgitation -- left ventricular assist devices -- prognosis -- heart failure -- right ventricular failure; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000001521
• Languages: English
• ISSNs: 1058-2916

Abstract

Abstract : We aimed to describe the natural history of left ventricular assist device (LVAD)-supported patients with preimplantation significant tricuspid regurgitation (TR) in a single-center retrospective analysis of LVAD-implanted patients (2008–2019). TR severity was assessed semiqualitatively using color-Doppler flow: insignificant TR (iTR) was defined as none/mild TR and significant TR (sTR) as ≥moderate TR. Included were 121 LVAD-supported patients of which 53% (n = 64) demonstrated sTR preimplantation. Among patients with pre-LVAD implantation sTR and available echocardiographic data, 55% (n = 26) ameliorated their TR severity grade to iTR during the first-year postsurgery and 55% (n = 17) had iTR at 2-year follow-up. On univariate analysis, predictors for TR severity improvement post-LVAD implantation were preimplant lack of atrial fibrillation, reduced inferior vena cavae diameter, and elevated pulmonary vascular resistance. In patients who failed to improve their TR severity grade, we observed a deterioration in right ventricular (RV) function (pulmonary artery pressure index 2.0 [1.7, 2.9], a decline in RV work index 242 [150, 471] mm Hg·L/m 2 ) and higher loop-diuretics dose requirement. At a median of 21 (IQR 8, 40) months follow-up, clinical LVAD-related complications, heart failure-hospitalizations, and overall survival were similar among patients who improved versus failed to improve their TR severity-grade post-LVAD implantation. In conclusion, LVAD implantation is accompanied by a reduction in TR severity in approximately 50% of patients. In patients who failed to improve their TR severity grade, progressive RV dysfunction was observed. Overall, an isolated LVAD implantation in patients with sTR does not adversely affect survival.