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Concomitant tricuspid valve surgery during implantation of continuous-flow left ventricular assist devices: a Society of Thoracic Surgeons database analysis.

Publication ,  Journal Article
Robertson, JO; Grau-Sepulveda, MV; Okada, S; O'Brien, SM; Matthew Brennan, J; Shah, AS; Itoh, A; Damiano, RJ; Prasad, S; Silvestry, SC
Published in: J Heart Lung Transplant
June 2014

BACKGROUND: Performing concomitant tricuspid valve procedures (TVPs) in left ventricular assist device (LVAD) patients with significant pre-operative tricuspid regurgitation (TR) is controversial, and no studies have been large enough to definitively guide therapy. METHODS: Between January 2006 and September 2012, 2,196 patients with moderate to severe pre-operative TR from 115 institutions underwent implantation of a continuous-flow left ventricular assist device (LVAD) as reported by The Society of Thoracic Surgeons National Database. Of these, 588 (27%) underwent a concomitant TVP. Inverse probability weighting based on propensity score was used to adjust for differences between the LVAD alone and LVAD+TVP groups, and outcomes were compared. RESULTS: Most patients in the LVAD+TVP group underwent an annuloplasty alone (81.1%). Concomitant TVP did not affect risk of post-operative right VAD insertion (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.49-1.36; p = 0.4310) or death (RR, 0.95; 95% CI, 0.68-1.33; p = 0.7658). However, TVP was associated with an increased risk for post-operative renal failure (RR, 1.53; 95% CI, 1.13-2.08; p = 0.0061), dialysis (RR, 1.49; 95% CI, 1.03-2.15; p = 0.0339), reoperation (RR, 1.24; 95% CI, 1.07-1.45; p = 0.0056), greater total transfusion requirement (RR, 1.03; 95% CI, 1.01-1.05; p = 0.0013), and hospital length of stay > 21 days (RR, 1.29; 95% CI, 1.16-1.43; p < 0.0001). Time on the ventilator and intensive care unit length of stay were also significantly prolonged for the LVAD+TVP group. CONCLUSIONS: Performing a concomitant TVP for continuous-flow LVAD patients with moderate to severe TR did not reduce early death or right VAD requirement and was associated with worse early post-operative outcomes. These data caution against routine concomitant TVP based solely on degree of pre-operative TR and suggest that additional selection criteria are needed to identify those patients in whom concomitant TVP may prevent post-operative right ventricular failure.

Duke Scholars

Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

June 2014

Volume

33

Issue

6

Start / End Page

609 / 617

Location

United States

Related Subject Headings

  • Tricuspid Valve Insufficiency
  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Propensity Score
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
  • Heart Failure
 

Citation

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Robertson, J. O., Grau-Sepulveda, M. V., Okada, S., O’Brien, S. M., Matthew Brennan, J., Shah, A. S., … Silvestry, S. C. (2014). Concomitant tricuspid valve surgery during implantation of continuous-flow left ventricular assist devices: a Society of Thoracic Surgeons database analysis. J Heart Lung Transplant, 33(6), 609–617. https://doi.org/10.1016/j.healun.2014.01.861
Robertson, Jason O., Maria V. Grau-Sepulveda, Shoichi Okada, Sean M. O’Brien, J. Matthew Brennan, Ashish S. Shah, Akinobu Itoh, Ralph J. Damiano, Sunil Prasad, and Scott C. Silvestry. “Concomitant tricuspid valve surgery during implantation of continuous-flow left ventricular assist devices: a Society of Thoracic Surgeons database analysis.J Heart Lung Transplant 33, no. 6 (June 2014): 609–17. https://doi.org/10.1016/j.healun.2014.01.861.
Robertson JO, Grau-Sepulveda MV, Okada S, O’Brien SM, Matthew Brennan J, Shah AS, et al. Concomitant tricuspid valve surgery during implantation of continuous-flow left ventricular assist devices: a Society of Thoracic Surgeons database analysis. J Heart Lung Transplant. 2014 Jun;33(6):609–17.
Robertson, Jason O., et al. “Concomitant tricuspid valve surgery during implantation of continuous-flow left ventricular assist devices: a Society of Thoracic Surgeons database analysis.J Heart Lung Transplant, vol. 33, no. 6, June 2014, pp. 609–17. Pubmed, doi:10.1016/j.healun.2014.01.861.
Robertson JO, Grau-Sepulveda MV, Okada S, O’Brien SM, Matthew Brennan J, Shah AS, Itoh A, Damiano RJ, Prasad S, Silvestry SC. Concomitant tricuspid valve surgery during implantation of continuous-flow left ventricular assist devices: a Society of Thoracic Surgeons database analysis. J Heart Lung Transplant. 2014 Jun;33(6):609–617.
Journal cover image

Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

June 2014

Volume

33

Issue

6

Start / End Page

609 / 617

Location

United States

Related Subject Headings

  • Tricuspid Valve Insufficiency
  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Propensity Score
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
  • Heart Failure