Tomoyuki Fujita1, Junjiro Kobayashi2, Hiroki Hata2, Osamu Seguchi3, Yoshihiro Murata3, Masanobu Yanase3, Takeshi Nakatani3. 1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Centre, Osaka, Japan tomofujita@nifty.com tfujita@hsp.ncvc.go.jp. 2. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Centre, Osaka, Japan. 3. Department of Transplantation, National Cerebral and Cardiovascular Centre, Osaka, Japan.
Abstract
OBJECTIVES: Although right heart failure (RVF) is an important issue in the management of patients with left ventricular assist devices (LVADs), the benefits of performing tricuspid valve repair in conjunction with LVAD implantation have not been demonstrated. METHODS: We retrospectively reviewed the records of 141 patients who received LVAD implantation as a bridge to transplant from May 1999 to January 2013. We assessed short- and long-term right heart function in 69 of these patients who underwent tricuspid valve repair because of moderate-to-severe tricuspid regurgitation (TR) or severe dilatation of the tricuspid annulus. RVF was defined as the need for a right ventricular assist device or >30 days of intravenous inotropic support. TR was graded from 0 to 4, while fibrosis in myocardial biopsy samples was graded pathologically from 0 to 3. RESULTS: The average duration of LVAD support was 595 days. Twenty-seven patients developed RVF and their survival rate was significantly worse than that of patients who did not develop RVF (65 vs 91% at 1 year). RVF was significantly related to high preoperative ratio of central venous pressure (CVP) to pulmonary capillary wedge pressure, high total bilirubin, high fibrosis score and high TR grade. In patients who underwent tricuspid valve repair, the TR grade was significantly reduced from 2.6 to 1.0, and this decrease was maintained for 2 years. Although patients who underwent tricuspid valve repair had significantly higher TR grades, ratios of CVP to pulmonary capillary wedge pressure and fibrosis scores preoperatively, no survival impairment was seen. CONCLUSIONS: Tricuspid valve repair is a useful and durable adjuvant procedure for restoring deteriorated right ventricular function in patients requiring LVAD implantation.
OBJECTIVES: Although right heart failure (RVF) is an important issue in the management of patients with left ventricular assist devices (LVADs), the benefits of performing tricuspid valve repair in conjunction with LVAD implantation have not been demonstrated. METHODS: We retrospectively reviewed the records of 141 patients who received LVAD implantation as a bridge to transplant from May 1999 to January 2013. We assessed short- and long-term right heart function in 69 of these patients who underwent tricuspid valve repair because of moderate-to-severe tricuspid regurgitation (TR) or severe dilatation of the tricuspid annulus. RVF was defined as the need for a right ventricular assist device or >30 days of intravenous inotropic support. TR was graded from 0 to 4, while fibrosis in myocardial biopsy samples was graded pathologically from 0 to 3. RESULTS: The average duration of LVAD support was 595 days. Twenty-seven patients developed RVF and their survival rate was significantly worse than that of patients who did not develop RVF (65 vs 91% at 1 year). RVF was significantly related to high preoperative ratio of central venous pressure (CVP) to pulmonary capillary wedge pressure, high total bilirubin, high fibrosis score and high TR grade. In patients who underwent tricuspid valve repair, the TR grade was significantly reduced from 2.6 to 1.0, and this decrease was maintained for 2 years. Although patients who underwent tricuspid valve repair had significantly higher TR grades, ratios of CVP to pulmonary capillary wedge pressure and fibrosis scores preoperatively, no survival impairment was seen. CONCLUSIONS: Tricuspid valve repair is a useful and durable adjuvant procedure for restoring deteriorated right ventricular function in patients requiring LVAD implantation.
Authors: Konstantin Zhigalov; Marcin Szczechowicz; Ahmed Mashhour; Bakitbek K Kadyraliev; Sabreen Mkalaluh; Jerry Easo; Juergen Ennker; Harald C Eichstaedt; Alexander Weymann Journal: J Thorac Dis Date: 2019-04 Impact factor: 2.895
Authors: Claudio J R Gomez Hamacher; Carolin Torregroza; Najla Sadat; Daniel Scheiber; Jil-Cathrin von der Beek; Ralf Westenfeld; Ivonne Jeanette Knorr; Martin Sager; Artur Lichtenberg; Diyar Saeed Journal: JTCVS Open Date: 2020-09-24