Kilcoyne Maxwell F, Chen Sarah, Sutton Sheldon, Mathi Roshan, Shorbaji Khaled, Foster John, Kwon Jennie, Welch Brett, Kilic Arman
Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC.
Division of Cardiac Anesthesiology, Medical University of South Carolina, Charleston, SC.
JTCVS Open. 2025 Feb 4;25:206-214. doi: 10.1016/j.xjon.2025.01.017. eCollection 2025 Jun.
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.
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.
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, = .03) and 3 years (r = 0.27, = .03). There was no significant difference in overall survival between groups at 2 years (79.0% vs 83.0%, = .89) and 3 years (79.0% vs 76.0%, = .89). At 2 years, there was no significant difference in the degree of tricuspid regurgitation between groups ( = .41), and 86.1% (n = 56) of patients had mild or less tricuspid regurgitation.
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.
左心室辅助装置植入期间严重三尖瓣反流的恰当管理尚不清楚。本研究评估左心室辅助装置植入后二尖瓣反流减轻对未矫正的严重三尖瓣反流的影响。
回顾了2016年1月至2022年12月期间接受HeartMate 3植入且术前存在中度或更严重三尖瓣反流的所有患者。排除术前无二尖瓣反流或接受了同期三尖瓣干预的患者。根据术后二尖瓣反流减轻程度将队列分组：第1组包括术后二尖瓣反流减轻程度为1.5度或更低的患者，第2组包括术后二尖瓣反流减轻程度超过1.5度的患者。主要结局包括三尖瓣反流与二尖瓣反流之间的关系以及总生存率，分别使用Pearson相关系数和Kaplan-Meier曲线进行计算。
在研究期间，共有178例患者接受了HeartMate 3植入，65例患者（36.5%）符合纳入标准。第1组（n = 35）和第2组（n = 30）的基线特征无显著差异。二尖瓣反流减轻与2年时（r = 0.25，P = .03）和3年时（r = 0.27，P = .03）的三尖瓣反流减轻显著相关。两组在2年时（79.0%对83.0%，P = .89）和3年时（79.0%对76.0%，P = .89）的总生存率无显著差异。在2年时，两组之间的三尖瓣反流程度无显著差异（P = .41），86.1%（n = 56）的患者三尖瓣反流为轻度或更低。
左心室辅助装置植入后，术前中度至重度三尖瓣反流随着二尖瓣反流减轻而改善。未来分析应评估这对同期三尖瓣修复患者选择的影响。
