Concurrent tricuspid valve surgery and LVAD implantation increases late all-cause mortality riskCombined Heart Surgery May Impact Long Term Survival Rates

ASAIO journal (American Society for Artificial Internal Organs : 1992) Published October 1, 2026 Study authors: Mastro Florinda, Gemelli Marco, Gallo Michele, Bortolato Alberto, Italiano Enrico G, Lorusso Roberto… PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Note that concurrent tricuspid valve surgery and LVAD implantation is associated with higher late all-cause mortality.

This meta-analysis evaluated outcomes in 2206 patients with advanced heart failure and tricuspid regurgitation to compare concomitant tricuspid valve surgery (TVS) with left ventricular assist device (LVAD) implantation against isolated LVAD implantation. The analysis focused on in-hospital outcomes and long-term survival metrics.

Key findings indicate that there was no significant difference in early mortality between the LVAD and LVAD plus TVS groups (OR: 1.18; 95% CI: 0.85-1.65; p = 0.3). However, the LVAD plus TVS group demonstrated a significantly higher risk of late all-cause mortality (HR: 0.82; 95% CI: 0.69-0.98; p = 0.032). Additionally, the odds of requiring a right ventricular assist device (RVAD) implant were significantly higher in the LVAD plus TVS group (OR: 1.36; 95% CI: 1.0-1.86; p = 0.05).

Clinicians should note that while concurrent tricuspid valve surgery does not appear to impact immediate operative mortality, it is associated with a higher risk of late mortality and RVAD requirement. The evidence is based on reconstructed time-to-event data. Specific limitations regarding the study were not reported.

How this fits prior evidence

This meta-analysis extends the evidence regarding mechanical circulatory support devices (MCSDs) for heart failure and cardiogenic shock populations. While prior evidence confirms that MCSDs improve hemodynamics and survival in selected populations, this study specifically addresses the impact of concurrent tricuspid valve surgery. It suggests that while the immediate survival benefit of MCSDs remains, the addition of concurrent tricuspid surgery may jeopardize long-term survival outcomes.

Researchers analyzed data from 2,206 patients with advanced heart failure and tricuspid regurgitation. The study compared two surgical approaches: performing a tricuspid valve surgery at the same time as a left ventricular assist device (LVAD) implantation, versus performing the LVAD implantation alone.

The results showed that patients who received both procedures simultaneously did not have a different rate of early mortality compared to those who only received the LVAD. However, the data revealed a significant link between the combined surgery and a higher risk of late all-cause mortality. Additionally, patients who underwent both procedures were more likely to require a right ventricular assist device (RVAD) later on.

Because this was a meta-analysis of reconstructed data, the findings show a link rather than a direct cause. These results suggest that while the combined surgery might not change immediate outcomes, it may impact long-term survival. Patients and doctors should discuss these specific risks and the trade-offs of combined procedures during treatment planning.

What this means for you:

Combined tricuspid surgery and LVAD showed no early survival difference but linked to higher long-term mortality.

Common questions

Does performing both surgeries at once improve immediate survival?

The study found no significant difference in early mortality between patients who received both tricuspid valve surgery and an LVAD, and those who received only an LVAD. This means the combined procedure did not change the immediate survival rates for these patients.

What are the long-term risks of combined heart surgeries?

Patients who underwent both tricuspid valve surgery and an LVAD implantation showed a significantly higher risk of late all-cause mortality. Additionally, these patients had a higher likelihood of needing a right ventricular assist device (RVAD) later in their treatment.

Who is affected by these findings?

These findings specifically concern patients with advanced heart failure and tricuspid regurgitation. Because the results show a link between combined procedures and higher long-term mortality, patients should discuss these specific risks with their medical team.

Study Details

Study typeMeta analysis

Sample sizen = 2,206

EvidenceLevel 1

PublishedOct 2026

PMID41430537

View Original Abstract ↓

Patients who undergo left ventricular assist device (LVAD) implantation may present with severe tricuspid regurgitation (TR), revealing underlying right heart failure. This study aims to evaluate the impact of concurrent tricuspid valve surgery (TVS) on LVAD implantation outcomes. Online electronic databases were systematically reviewed for studies including patients with advanced heart failure and TR treated by isolated LVAD implantation versus concomitant TVS and LVAD implantation. In-hospital outcomes were analyzed, and Kaplan-Meier (KM) curves presenting late survival by reconstruction of individual patient data. Sixteen studies were identified, comprising 2,206 patients who underwent either isolated LVAD or LVAD implant with concomitant TVS. There was no significant difference in early mortality between the two groups (odds ratio [OR]: 1.18, 95% confidence interval [CI]: 0.85-1.65, p = 0.3, I2 : 0%). The odds of right ventricular assist device (RVAD) implant were significantly higher in the LVAD + TVS group: (OR: 1.36 [95% CI: 1.0-1.86], p = 0.05). Analysis of late all-cause mortality showed a significantly higher risk of mortality in the LVAD + TVS group, hazard ratio (HR): 0.82 (0.69-0.98, p = 0.032) at each time-point. Tricuspid valve surgery at the same time as LVAD implant showed no difference in early operative mortality but jeopardized long-term survival. Future studies should aim to identify distinct patient subsets that could significantly benefit from TVS during the implantation of LVAD.

Concurrent tricuspid valve surgery and LVAD implantation increases late all-cause mortality riskCombined Heart Surgery May Impact Long Term Survival Rates

How this fits prior evidence

Common questions

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Concurrent tricuspid valve surgery and LVAD implantation increases late all-cause mortality riskCombined Heart Surgery May Impact Long Term Survival Rates

How this fits prior evidence

Common questions

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