Left Ventricular Assist Device Implantation and Concomitant Tricuspid Valve Surgery: A Systematic Review and Meta-Analysis of Reconstructed Time-to-Event Data.
Florinda Mastro, Marco Gemelli, Michele Gallo et al.
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In 30 seconds
This systematic review and meta-analysis compared outcomes after isolated left ventricular assist device (LVAD) implantation versus LVAD implantation with concomitant tricuspid valve surgery (TVS) in patients with advanced heart failure and tricuspid regurgitation. Sixteen studies included 2,206 patients; late survival was assessed using reconstructed individual patient data from Kaplan–Meier curves. Early mortality did not differ significantly between groups (OR 1.18, 95% CI 0.85-1.65, p = 0.3), while the TVS group had higher odds of right ventricular assist device implantation and a higher late mortality risk (HR 0.82 [0.69-0.98], p = 0.032, as reported).
Key findings
- Early mortality was not significantly different with concomitant TVS (OR: 1.18, 95% CI: 0.85-1.65, p = 0.3, I2 : 0%).
- RVAD implantation odds were higher in the LVAD + TVS group (OR: 1.36 [95% CI: 1.0-1.86], p = 0.05).
- Late all-cause mortality was reported as higher in the LVAD + TVS group (HR: 0.82 [0.69-0.98, p = 0.032) at each time-point.
Why it matters
The findings distinguish early operative mortality from later outcomes: adding TVS was not associated with a significant early mortality difference, but the pooled analysis reported higher RVAD use and worse late survival in the concomitant-surgery group. This highlights the importance of weighing potential right-sided valve intervention against observed outcomes while recognising that the evidence does not establish that TVS caused them.
What to keep in mind
The analysis pooled studies comparing treatment groups rather than reporting a randomised trial; late survival was reconstructed from Kaplan–Meier curves, and the abstract does not describe adjustment for differences between groups.