Tricuspid Valve Reconstruction in Patients with Right Heart Decompensation Due to Severe Tricuspid Regurgitation on LVAD Support.

Background/

Objectives

Right ventricular (RV) dysfunction after left ventricular assist device (LVAD) implantation is associated with reduced survival and affects duration of hospitalization. Some patients with RV dysfunction on LVAD have significant tricuspid valve regurgitation (TR) with concomitant signs of RV failure. In these cases, tricuspid valve repair (TVR) may minimize clinical signs of RV failure.

Methods

We report on two patients (one female, one male) developing significant TR receiving TVR through a right thoracotomy on LVAD support.

Results

The time between LVAD implantation and TVR was 4 months and 50 months, respectively. The female patient could be discharged from hospital without TR and any signs of RV dysfunction. The male patient died 13 days later due to septic shock following mesenteric ischemia. At this time, echocardiography showed a competent tricuspid valve.

Conclusions

In conclusion, these results provide insight into the clinical judgment of when TVR should be attempted. They suggest whether TVR may be a strategy to avoid hospitalization, minimize the clinical signs of RV insufficiency and improve quality of life in patients on LVAD support with severe TR and clinical signs of right heart dysfunction.