Durability and clinical impact of tricuspid valve procedures in patients receiving a continuous-flow left ventricular assist device

Jiho Han, Koji Takeda, Hiroo Takayama, Paul A. Kurlansky, Christine M. Mauro, Paolo C. Colombo, Melana Yuzefpolskaya, Shinichi Fukuhara, Lauren K. Truby, Veli K. Topkara, Arthur R. Garan, Donna M. Mancini, Yoshifumi Naka

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Objective Patients evaluated for a continuous-flow left ventricular assist device frequently present with severe right ventricular dysfunction with tricuspid regurgitation. Long-term outcomes of concurrent tricuspid valve procedures in continuous-flow left ventricular assist device implantation are unclear. Methods From May 2004 to December 2013, 336 patients received continuous-flow left ventricular assist devices. Among these, 8 patients with prior tricuspid valve procedures were excluded. At continuous-flow left ventricular assist device implantation, 76 patients underwent tricuspid valve procedures (group A), including 68 repairs and 8 replacements. The remaining 252 patients did not receive concurrent tricuspid valve procedures (group B). Results Preoperatively, group A had higher central venous pressure/pulmonary capillary wedge pressure (P =.032), total bilirubin (P =.009), and percentage of moderate or greater tricuspid regurgitation (98.7% vs 18.8%; P <.001). In group A, cardiopulmonary bypass time (136 ± 52.0 minutes vs 83.9 ± 38.8 minutes; P <.001), intraoperative platelet use (13.6 ± 6.70 units vs 11.7 ± 5.92 units; P =.042), and bleeding requiring reoperation (27.5% vs 16.7%; P =.046) were significantly increased. In-hospital mortality was similar (10.5% vs 6.4%; P =.22). On-device 2-year survival was 73.9% in group A and 74.2% in group B (P =.24). At 2 years, mean cumulative readmissions for right heart failure was 0.21 in group A and 0.27 in group B (P =.95). A generalized linear mixed-effects model showed that tricuspid valve procedures are protective for developing future significant tricuspid regurgitation (odds ratio, 0.38; 95% confidence interval, 0.19-0.76; P =.006). Conclusions Concomitant tricuspid valve procedures at continuous-flow left ventricular assist device implantation can be performed safely and are protective against worsening tricuspid regurgitation during the first 2 years of support.

Original languageEnglish
Pages (from-to)520-527.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume151
Issue number2
DOIs
StatePublished - 1 Feb 2016
Externally publishedYes

Keywords

  • right heart failure
  • tricuspid valve
  • ventricular assist device

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