Tricuspid surgery at the time of LVAD implant: A critique

Abstract

Tricuspid regurgitation (TR) is a common finding in patients with end stage heart failure referred for implantation of left ventricular assist devices. While functional TR frequently resolves after left ventricular unloading, patients with residual and progressive TR demonstrate increased rates of RV dysfunction and poor survival. Criteria for intervention on the tricuspid valve have focused on the degree of tricuspid annular dilatation and the severity of tricuspid regurgitant volume. The surgical decision making regarding intervention on the tricuspid valve remains obscure and historical cohort data cannot distinguish cause from effect.

Case report: Facilitating right heart recovery after durable LVAD implantation through repair of atrioventricular valves and RVAD implantation using tunneled Dacron grafts

“…Our group ( 2 , 10 ) and others ( 9 ) have also shown that residual MR after LVAD can contribute significantly to RV afterload, and establishment of mitral competence would be expected to reduce late right heart failure and readmissions. Conversely, the rationale for tricuspid valve repair is to promote right-sided forward flow and reduce the physiological impact of right heart dysfunction ( 11 , 12 ). Indeed, both the 2019 EACTS Expert Consensus on long-term mechanical circulatory support ( 13 ) and the 2023 International Society for Heart and Lung Transplantation Guidelines for Mechanical Circulatory Support ( 14 ) state that establishment of mitral competence for pre-LVAD severe MR and tricuspid repair for moderate or severe TR either can be considered or are recommended.…”