Tricuspid Regurgitation Can Improve After LVAD: Right Ventricular Reserve Should Not Be Overlooked

1/4 https://e-kcj.orgTricuspid regurgitation (TR) is frequently encountered in patients with advanced, medically refractory heart failure undergoing left ventricular assist device (LVAD) implantation. 1)Several retrospective studies have shown that around 50-80% of patients with significant preoperative TR experience improvement within 6 months following LVAD implantation. [2][3][4] In this issue of the Korean Circulation Journal, Shin et al. 5) present a carefully conducted singlecenter retrospective study evaluating the clinical implications and longitudinal evolution of significant TR in patients undergoing LVAD implantation without concomitant tricuspid valve intervention.Among 178 patients, of whom 37 had baseline moderate-to-severe TR, the authors demonstrate that significant TR was independently associated with early right ventricular (RV) failure within 30 days after LVAD implantation.Importantly, however, baseline TR severity was not associated with long-term outcomes, including all-cause mortality or heart failure hospitalization.Over follow-up, TR severity improved spontaneously in approximately 60% of patients, and hemodynamic optimization as well as functional recovery occurred regardless of baseline TR status.These findings reinforce prior observations that LV unloading alone can promote RV reverse remodeling and TR regression, questioning the routine need for concomitant tricuspid valve intervention at the time of LVAD implantation. 3)e study is methodologically sound, with detailed echocardiographic and invasive hemodynamic characterization and careful adjudication of early and late RV failure.The longitudinal assessment of TR severity and the visualization of TR transitions provide valuable insight into the dynamic nature of functional TR in the LVAD population.The authors' conclusion-that baseline moderate-to-severe TR predicts early RV failure but not long-term adverse outcomes-is well supported by the presented data.Nevertheless, several important considerations warrant emphasis to avoid potential overinterpretation of these results.First, the findings should not be misconstrued as evidence that severe TR in all clinical contexts is benign or inconsequential in LVAD candidates.Rather, TR must be interpreted in the broader context of underlying RV function.Numerous prior studies including mostly HeartMate 3 have shown that attempts