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

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 151; no. 2; pp. 520 - 527.e1
• Main Authors: Han, Jiho, BS, Takeda, Koji, MD, PhD, Takayama, Hiroo, MD, PhD, Kurlansky, Paul A., MD, Mauro, Christine M., PhD, Colombo, Paolo C., MD, Yuzefpolskaya, Melana, MD, Fukuhara, Shinichi, MD, Truby, Lauren K., MD, Topkara, Veli K., MD, Garan, Arthur R., MD, Mancini, Donna M., MD, Naka, Yoshifumi, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2016
• Subjects: Adult; Aged; Cardiac Valve Annuloplasty - adverse effects; Cardiac Valve Annuloplasty - mortality; Cardiothoracic Surgery; Female; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - mortality; Heart-Assist Devices; Hospital Mortality; Humans; Linear Models; Male; Middle Aged; Odds Ratio; Retrospective Studies; right heart failure; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome; tricuspid valve; Tricuspid Valve - physiopathology; Tricuspid Valve - surgery; Tricuspid Valve Insufficiency - diagnosis; Tricuspid Valve Insufficiency - mortality; Tricuspid Valve Insufficiency - physiopathology; Tricuspid Valve Insufficiency - surgery; ventricular assist device; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - therapy; Ventricular Dysfunction, Right - diagnosis; Ventricular Dysfunction, Right - mortality; Ventricular Dysfunction, Right - physiopathology; Ventricular Dysfunction, Right - surgery; Ventricular Function, Left; Ventricular Function, Right; RVAD; RV; CF-LVAD; HR; interquartile range; LVAD; TVP; RHF; tricuspid regurgitation; tricuspid valve procedure; cardiopulmonary bypass; continuous-flow left ventricular assist device; 27.2; tricuspid valve; right ventricular assist device; CI; right heart failure; IQR; central venous pressure; right ventricle, right ventricular; ventricular assist device; CPB; hazard ratio; confidence interval; left ventricular assist device; CVP; 35.6; TR
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2015.09.082

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.