Clinical Implications and Evolution of Significant Tricuspid Regurgitation in Patients Undergoing Left Ventricular Assist Device Implantation

BACKGROUND AND OBJECTIVES: Tricuspid regurgitation (TR) is common in advanced heart failure patients undergoing left ventricular assist device (LVAD) implantation, yet its independent prognostic value and post-LVAD trajectory remain uncertain. METHODS: This retrospective single-center study included 178 patients who underwent LVAD implantation without concomitant tricuspid valve intervention (TVI) between 2012 and 2024. Patients were stratified based on preoperative echocardiography into non-significant TR (n=141) and significant (≥ moderate) TR (n=37). Primary outcomes were early right ventricular (RV) failure, all-cause mortality and heart failure hospitalization. RESULTS: Significant baseline TR independently predicted early RV failure (odds ratio, 2.38; 95% confidence interval, 1.04 to 5.70; p=0.041), but was not associated with long-term outcomes, including all-cause mortality or heart failure hospitalization. During follow-up, TR severity improved in 60% of patients and most patients achieved hemodynamic optimization regardless of baseline TR severity. Functional recovery was observed in both groups, with a greater tendency of 6-minute walk improvement in patients with significant TR (p=0.057). CONCLUSIONS: Baseline moderate-to-severe TR predicts early RV failure but not long-term adverse outcomes following LVAD implantation. Most patients experience spontaneous TR improvement and achieve similar hemodynamic optimization regardless of baseline TR severity. These findings suggest LVAD support alone promotes RV reverse remodeling without requiring routine concomitant TVI.