Tricuspid valve repair with left ventricular assist device implantation: Is it warranted?

Valvular Heart Disease in Patients Supported With Left Ventricular Assist Devices

“…30 Potential benefits of TVR include reduced right atrial pressure and reduced sequelae of venous congestion, leading to improvement in renal and hepatic function. 25 Downsides might include longer operative time, increased bleeding risks, and potential for development of tricuspid stenosis.…”

“…Furthermore, there are no studies examining the impact of concomitant TVR on long-term outcomes, such as survival free of transplant, quality of life, and readmission rates. 30 Several single-center studies have examined the short-term impact of this procedure for moderate-to-severe TR 25,[30][31][32] ; however, to our knowledge, there have been no such multicenter studies.…”

“…Saeed et al 30 reported on 42 patients with moderate-to-severe TR undergoing LVAD implantation, with 8 patients receiving concomitant TVR. TVR prolonged the operative time and showed similar outcomes to LVAD implantation alone, including incidence of RV failure, end-organ function, and survival.…”

“…However, there is still potential risk for residual MR when device support cannot be optimized to provide low left-sided filling pressures, such as when there is suction of the interventricular septum over the inflow cannula at higher speeds or the need for intermittent AV opening. 30,35 Some have described the use of an edge-to-edge technique in the treatment of moderate-to-severe MR, which fixes the anterior leaflet to the posterior leaflet at a central location and may be effective for a central regurgitant jet. 38 It is important to note that exposure of the valve via the left atrium usually requires cardioplegic arrest and possibly increased operative risk.…”

Mechanical Circulatory Support for Advanced Heart Failure

“…22 Although some surgeons advocate prophylactic tricuspid valvuloplasty, other surgeons have shown no benefit. 77,78 Selection of patients for isolated LVAD will also be informed by our improved understanding of load-independent RV function (eg, RV stroke work index), pulmonary impedance, and RV contractile reserve. The right heart is central to all decisions surrounding LVAD therapy.…”