Outcomes Of Concomitant Tricuspid Valve Surgery During Left Ventricular Assist Device Implantation: An Analysis Of The EUROMACS Registry
Kevin M. Veen1, Kadir Caliskan, MD, PhD1, Theo M.M.H. de By, MBA2, Mostafa M. Mokhles, MD, PhD1, Osama I. Soliman, MD, PhD1, Paul Mohacsi, MD, eMBA3, Felix Schoenrath, MD, PhD4, Jan Gummert, MD, PhD5, Lech Paluszkiewicz, MD, PhD5, Ivan Netuka, MD, PhD6, Mustafa Ozbaran, MD7, Johanna J.M. Takkenberg, MD, PhD1, Ad J.J.C. Bogers, MD, PhD1, EUROMACS investigators2.
1Erasmus MC, Rotterdam, Netherlands, 2EUROMACS Registry, Windsor, United Kingdom, 3University Hospital Zurich, Zurich, Switzerland, 4German Heart Center Berlin, Berlin, Germany, 5Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany, 6Institute for Clinical and Experimental Medicine, Prague, Czech Republic, 7Ege University, Izmir, Turkey.
OBJECTIVE: Ongoing controversy exists whether concomitant tricuspid valve surgery (TVS) during a left ventricular assist device (LVAD) implantation is beneficial.
METHODS: The European Registry for Patients with Mechanical circulatory Support (EUROMACS) was used to identify adult patients. Propensity score matching was used to match patients with and without concomitant TVS. Competing risk models were used for cumulative incidence of unexpected readmission and right heart failure (RVF). Generalized mixed-models were used to model course of TR over time.
RESULTS: In total, 3323 patients underwent LVAD implantation between 1995-2018 of which 299(9%) had concomitant TVS. Propensity scores were used to match 258 patients with TVS to 258 patients without TVS. The absolute standardized difference for all baseline variables was <15%. In the matched population, hospital mortality, days on inotropic support, temporary right ventricular assist device implant and hospital stay were comparable, whereas intensive care stay was longer in the TVS cohort (11 vs. 15 days, P=0.026). Late mortality(P=0.17,Figure 1A), cumulative incidence of unexpected hospital readmission (P=0.146) and RVF (P=0.549) were comparable between patients with and without concomitant TVS. In the matched cohort, probability of moderate-to-severe TR immediately after surgery was lower in the TVS group compared to patients without TVS (33% vs 70%, P =0.001)(Figure 1b). Nevertheless, the probability of moderate-to-severe TR decreased more quickly in patients without TVS(P=0.03), resulting in comparable probabilities of moderate-to-severe TR within 1.5 year of follow-up.
CONCLUSIONS: Concomitant TVS significantly reduced TR early after LVAD implant, however, differences in probability of TR disappear during follow-up. Nevertheless, in matched patients concomitant TVS during LVAD implant does not seem to be associated with better clinical outcomes.
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