269. Impact of Mitral Regurgitation Reduction on Uncorrected Tricuspid Regurgitation after LVAD Implantation
Presented During: Adult Cardiac Scientific Session: Fads with VADs
University of Washington School of Medicine
Seattle, WA
United States - Contact Me
Jay Pal is Professor and Chief of Cardiac Surgery at the University of Washington. His clinical interests are in the surgical treatment of patients with advanced heart failure. In addition, he is involved in global surgery, and works on increasing access to cardiac surgical care in rural communities in Nepal, and providing continuing education for providers.
Medical University of South Carolina
Charleston, SC
United States - Contact Me
My name is Maxwell Kilcoyne and I am a 4th year integrated thoracic surgery resident at the Medical University of South Carolina. My clinical interests include all aspects of adult cardiac surgery and academic interests include outcomes-based and translational research.
Monday, April 29, 2024: 2:30 PM - 2:45 PM
15 Minutes
Metro Toronto Convention Center
Room: Room 717
Description
Objective: Appropriate management of preoperative tricuspid valve regurgitation (TR) during durable left ventricular assist device (LVAD) implantation represents a significant clinical challenge. This study evaluates the impact of post-LVAD mitral regurgitation (MR) reduction on uncorrected moderate to severe TR.
Methods: All patients who underwent LVAD implantation at our institution between January 2018 and December 2021 with preoperative moderate or greater TR were included. No patients had concomitant mitral valve intervention at the time of LVAD implant and those who underwent tricuspid valve repair were excluded. Postoperative echocardiogram data was collected up to 2 years post-LVAD implant. The cohort was divided based on postoperative MR reduction. The primary outcomes included the relationship between TR and MR and overall survival. Kaplan-Meier curves were used to calculate overall survival and Pearson correlation coefficient was used to assess the relationship between MR and TR.
Results: One hundred and eighteen patients underwent LVAD implantation during the study period, and uncorrected moderate to severe TR was identified preoperatively in 40 (33.9%) patients. Those patients were then divided into groups based on postoperative MR reduction, with 7 (17.5%) having no change, 13 (32.5%) having 1 degree, 14 (35.0%) having 2 degrees, and 6 (15.0%) having 3 degrees of MR reduction. There were no significant differences in baseline characteristics between groups. Postoperative improvement in MR was associated with TR reduction at 1-year (r=0.596, p =0.015) and 2-years (r=0.471, p=0.03). There was no significant difference in overall survival between those with unchanged and improved MR at 1-year (85.7% vs 81.4%, p=0.780) and 2-years postoperatively (85.7% vs 65.9%, p=0.520). At 2 years, there were no significant differences in the degree of TR between groups (p=0.365). Notably, 88% (n=22) of patients had no or mild TR at 2 years.
Conclusions: For preoperative moderate to severe TR, the presence and subsequent reduction of MR after LVAD implantation appears to correlate with TR improvement. Future analyses should assess the implication of preoperative MR on optimal patient selection for tricuspid valve repair at the time of LVAD implantation
Authors
Maxwell Kilcoyne (1), Sarah Chen (1), Khaled Shorbaji (1), John Foster (1), Jennie Kwon (1), Brett Welch (1), Arman Kilic (1)
Institutions
(1) Medical University of South Carolina, Charleston, SC
Methods: All patients who underwent LVAD implantation at our institution between January 2018 and December 2021 with preoperative moderate or greater TR were included. No patients had concomitant mitral valve intervention at the time of LVAD implant and those who underwent tricuspid valve repair were excluded. Postoperative echocardiogram data was collected up to 2 years post-LVAD implant. The cohort was divided based on postoperative MR reduction. The primary outcomes included the relationship between TR and MR and overall survival. Kaplan-Meier curves were used to calculate overall survival and Pearson correlation coefficient was used to assess the relationship between MR and TR.
Results: One hundred and eighteen patients underwent LVAD implantation during the study period, and uncorrected moderate to severe TR was identified preoperatively in 40 (33.9%) patients. Those patients were then divided into groups based on postoperative MR reduction, with 7 (17.5%) having no change, 13 (32.5%) having 1 degree, 14 (35.0%) having 2 degrees, and 6 (15.0%) having 3 degrees of MR reduction. There were no significant differences in baseline characteristics between groups. Postoperative improvement in MR was associated with TR reduction at 1-year (r=0.596, p =0.015) and 2-years (r=0.471, p=0.03). There was no significant difference in overall survival between those with unchanged and improved MR at 1-year (85.7% vs 81.4%, p=0.780) and 2-years postoperatively (85.7% vs 65.9%, p=0.520). At 2 years, there were no significant differences in the degree of TR between groups (p=0.365). Notably, 88% (n=22) of patients had no or mild TR at 2 years.
Conclusions: For preoperative moderate to severe TR, the presence and subsequent reduction of MR after LVAD implantation appears to correlate with TR improvement. Future analyses should assess the implication of preoperative MR on optimal patient selection for tricuspid valve repair at the time of LVAD implantation
Authors
Maxwell Kilcoyne (1), Sarah Chen (1), Khaled Shorbaji (1), John Foster (1), Jennie Kwon (1), Brett Welch (1), Arman Kilic (1)
Institutions
(1) Medical University of South Carolina, Charleston, SC
Presentation Duration
You will have a 6 minute presentation followed by 6 minutes of discussion with an assigned commentator. All presenters must adhere to the presentation and discussion times provided. The AATS will begin to play music once your speaking time is exceeded.