Relationship of Tricuspid Repair at the Time of Left Ventricular Assist Device Implantation and Survival

• Published in: International journal of artificial organs Vol. 37; no. 11; pp. 834 - 838
• Main Authors: Brewer, Robert J., Cabrera, Rafael, El-Atrache, Mazen, Zafar, Amna, Hrobowski, Tara N., Nemeh, Hassan M., Selektor, Yelena, Paone, Gaetano, Williams, Celeste T., Velez, Mauricio, Tita, Cristina, Morgan, Jeffrey A., Lanfear, David E.
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-11-2014
• Subjects: Adjustment; Adult; Aged; Cardiac Valve Annuloplasty - adverse effects; Cardiac Valve Annuloplasty - instrumentation; Cardiac Valve Annuloplasty - mortality; Chronic Disease; Female; Heart Failure - complications; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Heart-Assist Devices; Hemodynamics; Humans; Implantation; Kaplan-Meier Estimate; Logistic Models; Male; Mathematical models; Medical services; Middle Aged; Multivariate Analysis; Patients; Proportional Hazards Models; Prosthesis Design; Prosthesis Implantation - adverse effects; Prosthesis Implantation - instrumentation; Prosthesis Implantation - mortality; Repair; Retrospective Studies; Risk Factors; Severity of Illness Index; Survival; Time Factors; Treatment Outcome; Tricuspid Valve - physiopathology; Tricuspid Valve - surgery; Tricuspid Valve Insufficiency - complications; Tricuspid Valve Insufficiency - diagnosis; Tricuspid Valve Insufficiency - mortality; Tricuspid Valve Insufficiency - physiopathology; Tricuspid Valve Insufficiency - surgery; Ventricular assist devices; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - physiopathology; Ventricular Dysfunction, Right - prevention & control; Ventricular Function, Left; Ventricular Function, Right; Heart failure; Heart; Artificial; Tricuspid valve insufficiency; Cardiac valve annuloplasty
• ISSN: 0391-3988; 1724-6040
• DOI: 10.5301/ijao.5000369

Purpose
Tricuspid regurgitation contributes to right ventricular failure (RVF) and is associated with worse clinical outcomes in patients undergoing left ventricular assist device (LVAD) treatment. However, whether tricuspid valve repair (TVR) at the time of LVAD implantation improves outcomes is not clear.
Methods
We identified all patients undergoing initial implantation of a long-term continuous-flow LVAD at our institution from March 2006 to August 2011. We assessed the impact of TVR on survival and incidence of RVF using Kaplan-Meier curves and proportional hazards regression adjusted for age, gender, baseline tricuspid regurgitation, RV function, MELD score, albumin, and indication (bridge vs. destination).
Results
A total of 101 patients were included in the analysis, of which 14 patients underwent TVR concomitant LVAD. All TVR patients had moderate or severe baseline regurgitation. Crude survival was not different between groups. In multivariable models adjusted for confounding factors, TVR showed a significant association with improved survival (HR = 0.1, p = 0.049). Adjusted models showed no difference in RVF.
Conclusions
In this cohort of patients, TVR at the time of LVAD implantation appears associated with better survival. Additional larger studies are needed to verify the effect of TVR at the time of LVAD implantation, and whether it should be utilized more frequently.