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Thorac Cardiovasc Surg 2022; 70(06): 475-481
DOI: 10.1055/s-0042-1743594
Original Cardiovascular

Tricuspid Valve Surgery in Patients Receiving Left Ventricular Assist Devices

Hongtao Tie  ‡   *
1   Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
2   Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
,
Rui Shi‡   *
3   Service de médecine intensive-réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
,
Henryk Welp
1   Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
,
Sven Martens
1   Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
,
Zhenhan Li
4   Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Muenster, Muenster, Germany
,
Jürgen R. Sindermann
1   Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
,
Sabrina Martens
1   Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
› Author Affiliations
Funding None.
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Abstract

Background Tricuspid regurgitation (TR) is common and related to poor prognosis in patients after left ventricular assist device (LVAD) implantation. The concomitant tricuspid valve surgery (TVS) at the time of LVAD implantation on short and long-term outcomes are controversial in current evidence.

Methods This is a single-center, observational, retrospective study. We enrolled patients with moderate-to-severe TR who received LVAD implantations from 2009 to 2020. Postoperative right ventricular failure (RVF), right ventricular assist device (RVAD) use, hospital mortality, new-onset renal replacement therapy (RRT), and acute kidney injury (AKI) were evaluated retrospectively.

Results Sixty-eight patients were included, 36 with and 32 without concomitant TVS. Baseline characteristics did not differ between the two groups. Patients receiving TVS had significantly increased incidences of postoperative RVF (52.8 vs. 25.0%, p = 0.019), RVAD implantation (41.7 vs. 18.8%, p = 0.041), and new-onset RRT (22.2 vs. 0%, p = 0.004). No difference in the incidence of AKI and hospital mortality was detected. Besides, these associations remained consistent in patients who underwent LVAD implantation via median sternotomy. During a median follow-up of 2.76 years, Kaplan–Meier analysis and competing-risk analysis showed that TVS was not associated with better overall survival in patients after LVAD implantation compared with the no-TVS group.

Conclusion Our study suggests that concomitant TVS failed to show benefits in patients receiving LVAD implantation. Even worse, concomitant TVS is associated with significantly increased incidences of RVF, RVAD use, and new-onset of RRT. Considering the small sample size and short follow-up, these findings warrant further study.

Keywords

left ventricular assist device - heart failure - tricuspid valve surgery - retrospective study

* Both authors contributed equally to this work.


Author Contributions

H.T. and S.M. conceived the study and participated in the design. H.T., H.W., S.M., Z.L., and J.S. collected the data. H.T. and R.S. performed statistical analyses. H.T. and R.S. drafted the manuscript. Z.L. helped to draft the manuscript. S.M. revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.


Ethical Approval

This study was approved by the ethics committee of the Westfalen-Lippe Medical Association and the Westfälischen Wilhelms-Universität Münster (No. 2021-879-f-S).


Supplementary Material



Publication History

Received: 17 November 2021

Accepted: 24 January 2022

Article published online:
04 July 2022

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