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
11/24/2012Pubmed ID
23173864DOI
10.1111/jocs.12020Scopus ID
2-s2.0-84870198504 (requires institutional sign-in at Scopus site) 20 CitationsAbstract
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 LDAuthor
Lucian A. Durham MD, PhD Associate Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedCardiopulmonary 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