Faculty Collaboration Database

Surgical treatment of tricuspid valve insufficiency promotes early reverse remodeling in patients with axial-flow left ventricular assist devices. J Thorac Cardiovasc Surg 2012 Jun;143(6):1370-6

Date

08/16/2011

Pubmed ID

21839483

DOI

10.1016/j.jtcvs.2011.07.014

Scopus ID

2-s2.0-84861193194 (requires institutional sign-in at Scopus site)   60 Citations

Abstract

OBJECTIVE: The HeartMate II (Thoratec Corp, Pleasanton, Calif) continuous-flow left ventricular assist device has emerged as the standard of care for patients with advanced heart failure. The objective of this study was to assess the safety and early effectiveness of concomitant tricuspid valve procedures in patients undergoing implantation of a HeartMate II device.

METHODS: From February 2007 to April 2010, 83 patients underwent HeartMate II left ventricular assist device implantation. Of these, 37 patients had concomitant tricuspid valve procedures (32 repairs, 5 replacements) for severe tricuspid regurgitation. The effects of a tricuspid valve procedure on tricuspid regurgitation and right ventricular remodeling were assessed comparing echocardiographic findings at baseline and 30 days after left ventricular assist device implantation. Overall survival was also compared.

RESULTS: Patients undergoing a concomitant tricuspid valve procedure had more tricuspid regurgitation (vena contracta, 5.6 ± 2.1 mm vs 2.9 ± 2.0 mm; P < .001), worse right ventricular dysfunction (right ventricular end-diastolic area, 33.6 ± 6.2 mm vs 31.6 ± 8.5 mm; P = .05), higher mean right atrial pressure (17.4 ± 7.1 mm Hg vs 14.9 ± 5.1 mm Hg; P = .03), and a higher Kormos score (2.6 ± 2.1 vs 1.2 ± 1.4; P = .0008) preoperatively. One month after surgery, tricuspid regurgitation was worse in patients who underwent left ventricular assist device implantation alone (+18.6%), whereas it improved significantly in patients undergoing a concomitant tricuspid valve procedure (-50.2%) (P = .005). A corresponding significant reduction in right ventricular end-diastolic area (33.6% ± 6.2% vs 30.1% ± 9.7%; P = .03) and a trend toward better right ventricular function (55.5% ± 79.7% vs 35.7% ± 60.5%; P = .28) were noted in patients undergoing a concomitant tricuspid valve procedure. Survival was comparable between the 2 groups.

CONCLUSIONS: In patients with severe tricuspid regurgitation undergoing left ventricular assist device implantation, a concomitant tricuspid valve procedure effectively reduces tricuspid regurgitation and promotes reverse remodeling of the right ventricle.

Author List

Maltais S, Topilsky Y, Tchantchaleishvili V, McKellar SH, Durham LA, Joyce LD, Daly RC, Park SJ

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
Cardiac Valve Annuloplasty
Chi-Square Distribution
Disease-Free Survival
Female
Heart Failure
Heart Valve Prosthesis Implantation
Heart-Assist Devices
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Minnesota
Prosthesis Design
Retrospective Studies
Severity of Illness Index
Time Factors
Treatment Outcome
Tricuspid Valve Insufficiency
Ultrasonography
Ventricular Function, Left
Ventricular Function, Right
Ventricular Remodeling