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Concomitant tricuspid valve repair or replacement during left ventricular assist device implant demonstrates comparable outcomes in the long term. J Card Surg 2012 Nov;27(6):760-6

Date

11/24/2012

Pubmed ID

23173864

DOI

10.1111/jocs.12020

Scopus ID

2-s2.0-84870198504 (requires institutional sign-in at Scopus site)   20 Citations

Abstract

INTRODUCTION: Severe tricuspid regurgitation (TR) is present in nearly half the patients undergoing implant of a left ventricular assist device (LVAD) and its correction confers better long-term outcome.

AIM: To compare the early and late results of tricuspid valve repair (TVrpr) or replacement (TVR) with LVAD implant.

PATIENT AND METHODS: Sixty-four from a cohort of 126 patients had a concomitant tricuspid valve procedure; 48 (75%) underwent a TVrpr whereas 16 (25%) had TVR. All preoperative hemodynamic parameters including the mean TR grade (TVrpr; 3.6 vs. TVR; 3.7) were comparable (p = 0.7). The mean TR grade was 1.6 ± 1.5 for the remaining 62 patients who did not have a concomitant tricuspid valve procedure, with 4/62 (6%) having severe TR (p < 0.0001).

RESULTS: Cardiopulmonary bypass time was longer for patients undergoing TVR (p = 0.01). There was a significant reduction in right atrial pressure for the entire cohort (p < 0.01) and the postoperative right atrial pressure was not statistically different between TVrpr (13.6 ± 4.6) and TVR (11.6 ± 4.3; p = 0.6. Postoperative intensive care unit stay was comparable as was the duration of inotropic support (p = 0.5) or need for temporary right ventricular mechanical support. In-hospital mortality (12%) was not different between groups. The mean time for LVAD support was 12.3 ± 9.71 months and the last transthoracic echocardiographic examination was performed at mean intervals of 13.8 ± 10.8 months (TVrpr) and 11.8 ± 7.6 months (TVR; p = 0.47). Reduction in TR grade was similar between groups (p = 0.27). Late mortality (p = 1.00) was comparable in both groups. Using log-rank analysis, there was no significant difference in the estimated survival between TVrpr and TVR (p = 0.88).

CONCLUSION: TVrpr repair at the time of LVAD implant is effective in correcting TR even at the end of one year of follow-up. The choice to repair or replace does not affect the clinical outcome.

Author List

Deo SV, Hasin T, Altarabsheh SE, McKellar SH, Shah IK, Durham L 3rd, Stulak JM, Daly RC, Park SJ, Joyce LD

Author

Lucian A. Durham MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Cardiopulmonary Bypass
Cohort Studies
Female
Follow-Up Studies
Heart Failure
Heart Valve Prosthesis Implantation
Heart-Assist Devices
Hemodynamics
Humans
Male
Middle Aged
Retrospective Studies
Time Factors
Treatment Outcome
Tricuspid Valve
Tricuspid Valve Insufficiency