Abstract
Systemic right ventricular failure and significant systemic tricuspid regurgitation (TR) are common late complications in ccTGA and after atrial switch for TGA. VADs in the failing systemic right ventricle (SRV) have been used as bridge to transplant or candidacy. However, the impact of residual significant TR has not been established. The purpose of this study is to describe outcomes and hemodynamic changes of concomitant tricuspid valve replacement (TVR) at VAD implant.
Retrospective analysis of all adult patients who received an HVAD for SRV failure from 2010 to 2018 in our centre. Clinical characteristics, echocardiographic and right heart catheter studies performed before and at 6 months post VAD were analyzed and compared between those with concomitant TVR and those with significant residual TR.
A total of 18 patients (15 atrial switch, 3 ccTGA) underwent VAD implant. At least 15 patients had moderate TR, of whom 12 had significant subpulmonic left ventricular (SLV) impairment. TVR was performed at time of VAD in 6 patients. Patients with TVR showed significant reduction of SLV end-diastolic diameter after 6 months (44.3 vs 39.6mm; p=0.03), improvement of systolic LV function and significant reduction of pulmonary pressures compared to those with residual TR (figure 1). In those without concomitant TVR, there were 5 deaths, 2 related to SLV failure after 13 and 58 months, the other 4 patients were transplanted at a median length on support of 2353.5 days. There was 1 death in the TVR group after 10 months related to therapy non-compliance, the other 5 patients are in NYHA class I-II and listed for heart transplant (median length on support of 479 days).
TVR at the time of VAD implant in patients with SRV failure and TR is associated with a significant reduction of intracardiac pressures and improved LV dimension at 6 months post VAD. Whether or not concomitant TVR will prevent late SLV failure is to be determined.