Impact of mitral regurgitation reduction on uncorrected tricuspid regurgitation after left ventricular assist device implantation

Maxwell F. Kilcoyne DO , Sarah Chen MD , Sheldon Sutton MS , Roshan Mathi MS , Khaled Shorbaji MD , John Foster MD , Jennie Kwon MD , Brett Welch MBA , Arman Kilic MD
{"title":"Impact of mitral regurgitation reduction on uncorrected tricuspid regurgitation after left ventricular assist device implantation","authors":"Maxwell F. Kilcoyne DO ,&nbsp;Sarah Chen MD ,&nbsp;Sheldon Sutton MS ,&nbsp;Roshan Mathi MS ,&nbsp;Khaled Shorbaji MD ,&nbsp;John Foster MD ,&nbsp;Jennie Kwon MD ,&nbsp;Brett Welch MBA ,&nbsp;Arman Kilic MD","doi":"10.1016/j.xjon.2025.01.017","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Appropriate management of significant tricuspid regurgitation during left ventricular assist device implantation is unclear. This study evaluates the impact of post–left ventricular assist device mitral regurgitation reduction on uncorrected significant tricuspid regurgitation.</div></div><div><h3>Methods</h3><div>All patients who underwent HeartMate 3 implantation between January 2016 and December 2022 with preoperative moderate or greater tricuspid regurgitation were reviewed. Patients without preoperative mitral regurgitation or who underwent concomitant tricuspid valve intervention were excluded. The cohort was divided based on the degree of postoperative mitral regurgitation reduction: Group 1 included patients with 1.5 or less degrees of postoperative mitral regurgitation reduction, and group 2 included patients with more than 1.5 degrees. Primary outcomes included the relationship between tricuspid regurgitation and mitral regurgitation, and overall survival, which were calculated using Pearson correlation coefficient and Kaplan–Meier curves, respectively.</div></div><div><h3>Results</h3><div>A total of 178 patients underwent HeartMate 3 implantation during the study period, and 65 patients (36.5%) met inclusion criteria. There were no significant differences in baseline characteristics between group 1 (n = 35) and group 2 (n = 30). Mitral regurgitation reduction was significantly associated with tricuspid regurgitation reduction at 2 years (r = 0.25, <em>P</em> = .03) and 3 years (r = 0.27, <em>P</em> = .03). There was no significant difference in overall survival between groups at 2 years (79.0% vs 83.0%, <em>P</em> = .89) and 3 years (79.0% vs 76.0%, <em>P</em> = .89). At 2 years, there was no significant difference in the degree of tricuspid regurgitation between groups (<em>P</em> = .41), and 86.1% (n = 56) of patients had mild or less tricuspid regurgitation.</div></div><div><h3>Conclusions</h3><div>Preoperative moderate to severe tricuspid regurgitation improves with mitral regurgitation reduction after left ventricular assist device implantation. Future analyses should assess how this impacts patient selection for concomitant tricuspid valve repair.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"25 ","pages":"Pages 206-214"},"PeriodicalIF":0.0000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666273625000440","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Objective

Appropriate management of significant tricuspid regurgitation during left ventricular assist device implantation is unclear. This study evaluates the impact of post–left ventricular assist device mitral regurgitation reduction on uncorrected significant tricuspid regurgitation.

Methods

All patients who underwent HeartMate 3 implantation between January 2016 and December 2022 with preoperative moderate or greater tricuspid regurgitation were reviewed. Patients without preoperative mitral regurgitation or who underwent concomitant tricuspid valve intervention were excluded. The cohort was divided based on the degree of postoperative mitral regurgitation reduction: Group 1 included patients with 1.5 or less degrees of postoperative mitral regurgitation reduction, and group 2 included patients with more than 1.5 degrees. Primary outcomes included the relationship between tricuspid regurgitation and mitral regurgitation, and overall survival, which were calculated using Pearson correlation coefficient and Kaplan–Meier curves, respectively.

Results

A total of 178 patients underwent HeartMate 3 implantation during the study period, and 65 patients (36.5%) met inclusion criteria. There were no significant differences in baseline characteristics between group 1 (n = 35) and group 2 (n = 30). Mitral regurgitation reduction was significantly associated with tricuspid regurgitation reduction at 2 years (r = 0.25, P = .03) and 3 years (r = 0.27, P = .03). There was no significant difference in overall survival between groups at 2 years (79.0% vs 83.0%, P = .89) and 3 years (79.0% vs 76.0%, P = .89). At 2 years, there was no significant difference in the degree of tricuspid regurgitation between groups (P = .41), and 86.1% (n = 56) of patients had mild or less tricuspid regurgitation.

Conclusions

Preoperative moderate to severe tricuspid regurgitation improves with mitral regurgitation reduction after left ventricular assist device implantation. Future analyses should assess how this impacts patient selection for concomitant tricuspid valve repair.
减少二尖瓣反流对左心室辅助装置植入后未矫正三尖瓣反流的影响
目的对左心室辅助装置植入过程中明显三尖瓣反流的处理尚不明确。本研究评估左心室辅助装置后二尖瓣返流减少对未矫正的显著三尖瓣返流的影响。方法回顾性分析2016年1月至2022年12月期间,所有术前出现中度或重度三尖瓣反流的患者行心脏伴侣3号植入手术。术前无二尖瓣反流或同时进行三尖瓣干预的患者被排除在外。根据术后二尖瓣返流降低程度分组:1组为术后二尖瓣返流降低1.5度及以下患者,2组为术后二尖瓣返流降低1.5度以上患者。主要结局包括三尖瓣反流和二尖瓣反流与总生存的关系,分别采用Pearson相关系数和Kaplan-Meier曲线计算。结果研究期间共178例患者行心脏伴侣3植入,符合纳入标准的患者65例(36.5%)。组1 (n = 35)和组2 (n = 30)的基线特征无显著差异。在2年(r = 0.25, P = 0.03)和3年(r = 0.27, P = 0.03)时,二尖瓣返流减少与三尖瓣返流减少显著相关。两组患者2年(79.0% vs 83.0%, P = 0.89)和3年(79.0% vs 76.0%, P = 0.89)总生存率无显著差异。2年时,两组患者三尖瓣反流程度差异无统计学意义(P = 0.41), 86.1% (n = 56)患者三尖瓣反流轻度或轻度。结论植入左心室辅助装置后,术中至重度三尖瓣返流得到改善,二尖瓣返流减少。未来的分析应评估这如何影响患者选择合并三尖瓣修复。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
1.70
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信