Clinical impact of concomitant tricuspid valve procedures during left ventricular assist device implantation.
Published
Journal Article
BACKGROUND: Almost 50% of patients referred for implantable left ventricular assist device (LVAD) have significant tricuspid regurgitation (TR). Preoperative TR is associated with negative outcomes but the clinical benefit of concomitant tricuspid valve procedures has not been extensively studied. METHODS: One hundred fifteen patients, undergoing implantable LVADs, were identified as having significant TR by echocardiography prior to their surgical procedure. Patients underwent either LVAD alone (n = 81) versus LVAD plus concomitant tricuspid procedures (n = 34) (29 annuloplasty ring repairs and 5 bioprosthetic replacements.) Preoperative characteristics and hemodynamics, as well as TR severity and clinical outcomes were retrospectively determined from chart and database review and compared for the two groups. RESULTS: Preoperative characteristics and hemodynamics were similar for the two groups. Postoperative TR was markedly reduced for the group undergoing concomitant procedures versus LVAD alone. A temporary right ventricular assist device was required for only one of the 34 cases in which concomitant tricuspid procedures were performed; for patients undergoing LVAD alone, 8 of 81 required right ventricular assist devices. Mean duration of postoperative inotrope utilization was increased for the LVAD alone group versus the group with concomitant tricuspid procedures (10.0 vs 8.0 days, respectively, p = 0.04). The incidence of postoperative renal dysfunction was increased for the LVAD alone group (39%) versus concomitant procedures (21%) (p = 0.05). The LVAD alone group also had a greater mean postimplant length of hospitalization versus the concomitant procedures group (26.0 vs 19.0 days, p = 0.02). Finally, there was a trend toward improved survival for the group with concomitant tricuspid procedures versus LVAD alone. CONCLUSIONS: For patients with significant TR undergoing implantable LVAD procedures, concomitant tricuspid procedures are associated with improved early clinical outcomes.
Full Text
Duke Authors
- Felker, Gary Michael
- Lodge, Andrew James
- Milano, Carmelo Alessio
- Rogers, Joseph G.
- Stafford-Smith, Mark
- Swaminathan, Madhav
Cited Authors
- Piacentino, V; Troupes, CD; Ganapathi, AM; Blue, LJ; Mackensen, GB; Swaminathan, M; Felker, GM; Stafford-Smith, M; Lodge, AJ; Rogers, JG; Milano, CA
Published Date
- October 2011
Published In
Volume / Issue
- 92 / 4
Start / End Page
- 1414 - 1418
PubMed ID
- 21958790
Pubmed Central ID
- 21958790
Electronic International Standard Serial Number (EISSN)
- 1552-6259
Digital Object Identifier (DOI)
- 10.1016/j.athoracsur.2011.05.084
Language
- eng
Conference Location
- Netherlands