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J. Thorac. Cardiovasc. Surg. · Sep 2024
Late Follow-up for a Randomized Trial of Surgical Treatment of Tricuspid Valve Regurgitation in Patients Undergoing Left Ventricular Assist Device Implantation.
- PlaMichelle MendiolaMMDivision of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC. Electronic address: michelle.mendiola.pla@duke.edu., Stuart D Russell, Carmelo A Milano, Yuting Chiang, Lillian Kang, Emily Poehlein, Cynthia L Green, Frank Benedetti, Han Billard, Benjamin S Bryner, Jacob N Schroder, Mani A Daneshmand, Alina Nicoara, Adam D DeVore, Chetan B Patel, and Muath Bishawi.
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC. Electronic address: michelle.mendiola.pla@duke.edu.
- J. Thorac. Cardiovasc. Surg. 2024 Sep 21.
ObjectivesWe previously reported that concurrent tricuspid valve surgery (TVS) was not associated with a lower incidence of early RHF among patients undergoing durable LVAD implantation. This is a follow-up analysis to further define the clinical impact of concurrent TVS within 12-months of follow-up.MethodsPatients with moderate or severe TR on pre-operative echocardiography (n=71) were randomized to either LVAD implantation alone (No TVS, n=34) or with concurrent TVS (TVS, n=37). Randomization was stratified by pre-operative right ventricular dysfunction. Patients were followed for at least 12-months after surgery. The incidence of RHF was determined using INTERMACS criteria by an adjudication committee. Functional studies and repeat echocardiography were performed at 12-months.ResultsDemographics were similar between the two arms. At 12-months, the rate of moderate or severe RHF was 50.0% (No TVS) versus 51.4% (TVS). No patients developed RHF between 6- and 12-months following the procedure. Death from RHF was 5.4% (TVS) versus 8.8% (No TVS). At 12-months, there was no significant difference in TR severity between the two arms due to improvement in TR severity in the No TVS arm. On cardiopulmonary exercise testing at 12+ months, there was no significant difference in peak oxygen consumption.ConclusionsIn patients with significant pre-implant TR, the severity of TR improved over time in the LVAD implantation alone arm. By 12-months, there is no significant difference in TR severity between the two arms. This may account for the lack of difference in late clinical or functional parameters.Copyright © 2024. Published by Elsevier Inc.
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