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Ventricular assist device (VAD) for systemic right ventricular failure (SRVF) post atrial switch for transposition of the great arteries (TGA) and congenitally corrected TGA (ccTGA) has proven useful to reduce transpulmonary gradient (TPG) and bridge-to-transplantation. The hemodynamic impact of severe tricuspid regurgitation (TR), potential role of systemic tricuspid valve replacement (TVR) and long-term outcomes are still unknown. The purpose of this study is to describe our experience of VAD in SRVF and our move towards concomitant TVR. Single-centre retrospective study of consecutive adult patients receiving HeartWare-VAD for SRVF between 2010 and 2020. From 2017, concomitant TVR was performed routinely. Demographic, clinical variables and echocardiographic and haemodynamic measurements pre and post VAD implantation were recorded. Complications on support, heart transplantation and survival rates were described. 24 patients underwent VAD implantation. Moderate or severe systemic TR was present in 83% of patients, and subpulmonic left ventricular (LV) impairment in 79%. One and two-year survival rates were 75% and 60% respectively. VAD implantation was technically feasible and successful in all but one. Post VAD, TPG fell from 16 (15-20) to 10 (7-13) mmHg; p=0.002. Patients with TVR (n=12) also demonstrated reduction in pulmonary and atrial pressures (figure). Subpulmonic LV end-diastolic dimension (50 vs 42mm; p=0.05) and systolic function improved in this group. On the other hand a high prevalence of subpulmonic LV failure was noted in the non TVR group (50% vs 8.3%; p=0.03) resulting in higher mortality. After six months on support, 63% of patients were suitable for transplantation. VAD implantation for patients with SRVF in TGA or ccTGA is feasible, and significantly reduces the TPG to transplantable limits. Concomitant TVR at the time of implant associates better haemodynamic and echocardiographic results. [ABSTRACT FROM AUTHOR]

Systemic right ventricular failure and significant systemic tricuspid regurgitation (TR) are common late complications in ccTGA and after atrial switch for TGA. VADs in the failing systemic right ventricle (SRV) have been used as bridge to transplant or candidacy. However, the impact of residual significant TR has not been established. The purpose of this study is to describe outcomes and hemodynamic changes of concomitant tricuspid valve replacement (TVR) at VAD implant. Retrospective analysis of all adult patients who received an HVAD for SRV failure from 2010 to 2018 in our centre. Clinical characteristics, echocardiographic and right heart catheter studies performed before and at 6 months post VAD were analyzed and compared between those with concomitant TVR and those with significant residual TR. A total of 18 patients (15 atrial switch, 3 ccTGA) underwent VAD implant. At least 15 patients had moderate TR, of whom 12 had significant subpulmonic left ventricular (SLV) impairment. TVR was performed at time of VAD in 6 patients. Patients with TVR showed significant reduction of SLV end-diastolic diameter after 6 months (44.3 vs 39.6mm; p=0.03), improvement of systolic LV function and significant reduction of pulmonary pressures compared to those with residual TR (figure 1). In those without concomitant TVR, there were 5 deaths, 2 related to SLV failure after 13 and 58 months, the other 4 patients were transplanted at a median length on support of 2353.5 days. There was 1 death in the TVR group after 10 months related to therapy non-compliance, the other 5 patients are in NYHA class I-II and listed for heart transplant (median length on support of 479 days). TVR at the time of VAD implant in patients with SRV failure and TR is associated with a significant reduction of intracardiac pressures and improved LV dimension at 6 months post VAD. Whether or not concomitant TVR will prevent late SLV failure is to be determined. [ABSTRACT FROM AUTHOR]