Tricuspid valve repair with left ventricular assist device implantation: Is it warranted?

Diyar Saeed, Trilokesh Kidambi, Shanaz Shalli, Brittany Lapin, S. Chris Malaisrie, Richard Lee, William G. Cotts, Edwin C. McGee

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Background: Tricuspid regurgitation is common in patients with advanced heart failure. The ideal operative strategy for managing tricuspid valve regurgitation (TR) in patients undergoing left ventricular assist device (LVAD) implantation is unclear. This study was designed to evaluate the effect on outcomes of concomitant tricuspid valve repair (TVR) for moderate to severe (3+/4+) TR at the time of LVAD implantation. Methods: Patients with >3+ TR who underwent LVAD implantation from 2005 to 2009 were retrospectively evaluated. Pre-, intra- and post-operative data, including hemodynamics, inotrope requirements and end-organ function parameters, were considered. Outcomes of patients receiving TVR were compared with those who did not receive TVR (NTVR). Results: Seventy-two LVADs were implanted during the study period. Forty-two (58%) patients had <3+ TR prior to LVAD implantation. Eight patients underwent TVR and 34 patients did not undergo TVR (NTVR). There were no significant differences in baseline characteristics or severity of TR between the two groups. The TVR group had a longer cardiopulmonary bypass time (p < 0.01) and required more blood products (p < 0.05). Higher post-operative creatinine and blood urea nitrogen (BUN) values were noted in the TVR group. One patient in the TVR group and 3 patients in the NTVR group required right-sided mechanical assistance (p = 0.6). There was no significant difference in short- or long-term mortality between the two groups. Conclusions: TVR for <3+ TR prolonged operative time and showed similar outcomes compared with LVAD implantation alone. A benefit of performing TVR was not demonstrated. As such, TVR may not be necessary at the time of LVAD implantation.

Original languageEnglish (US)
Pages (from-to)530-535
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume30
Issue number5
DOIs
StatePublished - May 1 2011
Externally publishedYes

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Heart-Assist Devices
Tricuspid Valve
Tricuspid Valve Insufficiency
Blood Urea Nitrogen
Operative Time
Cardiopulmonary Bypass
Creatinine
Heart Failure
Hemodynamics

Keywords

  • heart failure
  • right heart failure
  • tricuspid regurgitation
  • ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Tricuspid valve repair with left ventricular assist device implantation : Is it warranted? / Saeed, Diyar; Kidambi, Trilokesh; Shalli, Shanaz; Lapin, Brittany; Malaisrie, S. Chris; Lee, Richard; Cotts, William G.; McGee, Edwin C.

In: Journal of Heart and Lung Transplantation, Vol. 30, No. 5, 01.05.2011, p. 530-535.

Research output: Contribution to journalArticle

Saeed, Diyar ; Kidambi, Trilokesh ; Shalli, Shanaz ; Lapin, Brittany ; Malaisrie, S. Chris ; Lee, Richard ; Cotts, William G. ; McGee, Edwin C. / Tricuspid valve repair with left ventricular assist device implantation : Is it warranted?. In: Journal of Heart and Lung Transplantation. 2011 ; Vol. 30, No. 5. pp. 530-535.
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abstract = "Background: Tricuspid regurgitation is common in patients with advanced heart failure. The ideal operative strategy for managing tricuspid valve regurgitation (TR) in patients undergoing left ventricular assist device (LVAD) implantation is unclear. This study was designed to evaluate the effect on outcomes of concomitant tricuspid valve repair (TVR) for moderate to severe (3+/4+) TR at the time of LVAD implantation. Methods: Patients with >3+ TR who underwent LVAD implantation from 2005 to 2009 were retrospectively evaluated. Pre-, intra- and post-operative data, including hemodynamics, inotrope requirements and end-organ function parameters, were considered. Outcomes of patients receiving TVR were compared with those who did not receive TVR (NTVR). Results: Seventy-two LVADs were implanted during the study period. Forty-two (58{\%}) patients had <3+ TR prior to LVAD implantation. Eight patients underwent TVR and 34 patients did not undergo TVR (NTVR). There were no significant differences in baseline characteristics or severity of TR between the two groups. The TVR group had a longer cardiopulmonary bypass time (p < 0.01) and required more blood products (p < 0.05). Higher post-operative creatinine and blood urea nitrogen (BUN) values were noted in the TVR group. One patient in the TVR group and 3 patients in the NTVR group required right-sided mechanical assistance (p = 0.6). There was no significant difference in short- or long-term mortality between the two groups. Conclusions: TVR for <3+ TR prolonged operative time and showed similar outcomes compared with LVAD implantation alone. A benefit of performing TVR was not demonstrated. As such, TVR may not be necessary at the time of LVAD implantation.",
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T2 - Is it warranted?

AU - Saeed, Diyar

AU - Kidambi, Trilokesh

AU - Shalli, Shanaz

AU - Lapin, Brittany

AU - Malaisrie, S. Chris

AU - Lee, Richard

AU - Cotts, William G.

AU - McGee, Edwin C.

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AB - Background: Tricuspid regurgitation is common in patients with advanced heart failure. The ideal operative strategy for managing tricuspid valve regurgitation (TR) in patients undergoing left ventricular assist device (LVAD) implantation is unclear. This study was designed to evaluate the effect on outcomes of concomitant tricuspid valve repair (TVR) for moderate to severe (3+/4+) TR at the time of LVAD implantation. Methods: Patients with >3+ TR who underwent LVAD implantation from 2005 to 2009 were retrospectively evaluated. Pre-, intra- and post-operative data, including hemodynamics, inotrope requirements and end-organ function parameters, were considered. Outcomes of patients receiving TVR were compared with those who did not receive TVR (NTVR). Results: Seventy-two LVADs were implanted during the study period. Forty-two (58%) patients had <3+ TR prior to LVAD implantation. Eight patients underwent TVR and 34 patients did not undergo TVR (NTVR). There were no significant differences in baseline characteristics or severity of TR between the two groups. The TVR group had a longer cardiopulmonary bypass time (p < 0.01) and required more blood products (p < 0.05). Higher post-operative creatinine and blood urea nitrogen (BUN) values were noted in the TVR group. One patient in the TVR group and 3 patients in the NTVR group required right-sided mechanical assistance (p = 0.6). There was no significant difference in short- or long-term mortality between the two groups. Conclusions: TVR for <3+ TR prolonged operative time and showed similar outcomes compared with LVAD implantation alone. A benefit of performing TVR was not demonstrated. As such, TVR may not be necessary at the time of LVAD implantation.

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KW - right heart failure

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KW - ventricular assist device

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