TY - JOUR
T1 - Durability and clinical impact of tricuspid valve procedures in patients receiving a continuous-flow left ventricular assist device
AU - Han, Jiho
AU - Takeda, Koji
AU - Takayama, Hiroo
AU - Kurlansky, Paul A.
AU - Mauro, Christine M.
AU - Colombo, Paolo C.
AU - Yuzefpolskaya, Melana
AU - Fukuhara, Shinichi
AU - Truby, Lauren K.
AU - Topkara, Veli K.
AU - Garan, Arthur R.
AU - Mancini, Donna M.
AU - Naka, Yoshifumi
N1 - Publisher Copyright:
© 2016 The American Association for Thoracic Surgery.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - 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.
AB - 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.
KW - right heart failure
KW - tricuspid valve
KW - ventricular assist device
UR - http://www.scopus.com/inward/record.url?scp=84957630625&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2015.09.082
DO - 10.1016/j.jtcvs.2015.09.082
M3 - Article
C2 - 26806510
AN - SCOPUS:84957630625
SN - 0022-5223
VL - 151
SP - 520-527.e1
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 2
ER -