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

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.