Left Ventricular Assist Device Implantation and Concomitant Tricuspid Valve Surgery: A Systematic Review and Meta-Analysis of Reconstructed Time-to-Event Data.

Abstract

Patients who undergo left ventricular assist device (LVAD) implantation may present with severe tricuspid regurgitation (TR), revealing underlying right heart failure. This study aims to evaluate the impact of concurrent tricuspid valve surgery (TVS) on LVAD implantation outcomes. Online electronic databases were systematically reviewed for studies including patients with advanced heart failure and TR treated by isolated LVAD implantation versus concomitant TVS and LVAD implantation. In-hospital outcomes were analyzed, and Kaplan-Meier (KM) curves presenting late survival by reconstruction of individual patient data. Sixteen studies were identified, comprising 2,206 patients who underwent either isolated LVAD or LVAD implant with concomitant TVS. There was no significant difference in early mortality between the two groups (odds ratio [OR]: 1.18, 95% confidence interval [CI]: 0.85-1.65, p = 0.3, I2 : 0%). The odds of right ventricular assist device (RVAD) implant were significantly higher in the LVAD + TVS group: (OR: 1.36 [95% CI: 1.0-1.86], p = 0.05). Analysis of late all-cause mortality showed a significantly higher risk of mortality in the LVAD + TVS group, hazard ratio (HR): 0.82 (0.69-0.98, p = 0.032) at each time-point. Tricuspid valve surgery at the same time as LVAD implant showed no difference in early operative mortality but jeopardized long-term survival. Future studies should aim to identify distinct patient subsets that could significantly benefit from TVS during the implantation of LVAD.