Howard K Song1, Jill M Gelow2, James Mudd2, Christopher Chien2, Frederick A Tibayan3, Kathryn Hollifield4, David Naftel4, James Kirklin4. 1. Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Oregon. Electronic address: songh@ohsu.edu. 2. Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, Oregon. 3. Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Oregon. 4. Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Abstract
BACKGROUND: The optimal management of tricuspid regurgitation (TR) in patients undergoing left ventricular assist device (LVAD) implantation is controversial. This study was undertaken to determine the impact of tricuspid valve repair (TVR) at the time of LVAD implantation on survival. METHODS: The Interagency Registry for Mechanically Assisted Circulatory Support was used to analyze the outcomes of patients undergoing LVAD implantation as destination therapy with or without concomitant TVR. RESULTS: Among 2,527 patients undergoing implant of a continuous flow LVAD as destination therapy during the study period, 989 (39%) had moderate or severe TR. The management of TR was not uniform among these patients. Patients with moderate and severe TR underwent TVR in 16.7% and 35.3% of cases, respectively. Moderate and severe TR at the time of LVAD implantation were associated with poorer survival over the entire follow-up period (p = 0.009). Interestingly, TVR at the time of LVAD implantation did not confer improved survival, even among patients with preimplant moderate or severe TR. A potential explanation for this finding is that patients with preimplant moderate or severe TR who underwent LVAD implant with concomitant TVR commonly experienced recurrent, late TR (21% to 27%). CONCLUSIONS: Tricuspid valve repair is performed commonly at the time of LVAD implant despite the fact that it does not confer a clear survival benefit. For many patients, LVAD implant alone relieves preimplant TR as effectively as LVAD implant with TVR. Further study is necessary to determine what factors lead to recurrence of late TR in LVAD patients both with and without TVR.
BACKGROUND: The optimal management of tricuspid regurgitation (TR) in patients undergoing left ventricular assist device (LVAD) implantation is controversial. This study was undertaken to determine the impact of tricuspid valve repair (TVR) at the time of LVAD implantation on survival. METHODS: The Interagency Registry for Mechanically Assisted Circulatory Support was used to analyze the outcomes of patients undergoing LVAD implantation as destination therapy with or without concomitant TVR. RESULTS: Among 2,527 patients undergoing implant of a continuous flow LVAD as destination therapy during the study period, 989 (39%) had moderate or severe TR. The management of TR was not uniform among these patients. Patients with moderate and severe TR underwent TVR in 16.7% and 35.3% of cases, respectively. Moderate and severe TR at the time of LVAD implantation were associated with poorer survival over the entire follow-up period (p = 0.009). Interestingly, TVR at the time of LVAD implantation did not confer improved survival, even among patients with preimplant moderate or severe TR. A potential explanation for this finding is that patients with preimplant moderate or severe TR who underwent LVAD implant with concomitant TVR commonly experienced recurrent, late TR (21% to 27%). CONCLUSIONS: Tricuspid valve repair is performed commonly at the time of LVAD implant despite the fact that it does not confer a clear survival benefit. For many patients, LVAD implant alone relieves preimplant TR as effectively as LVAD implant with TVR. Further study is necessary to determine what factors lead to recurrence of late TR in LVADpatients both with and without TVR.
Authors: O H Frazier; Nyma A Shah; Timothy J Myers; Kimberly D Robertson; Igor D Gregoric; Reynolds Delgado Journal: Cardiology Date: 2004 Impact factor: 1.869
Authors: Michael Dandel; Yuguo Weng; Henryk Siniawski; Evgenij Potapov; Hans B Lehmkuhl; Roland Hetzer Journal: Circulation Date: 2005-08-30 Impact factor: 29.690
Authors: Marian Kukucka; Alexander Stepanenko; Evgenij Potapov; Thomas Krabatsch; Mathias Redlin; Alexander Mladenow; Hermann Kuppe; Roland Hetzer; Helmut Habazettl Journal: J Heart Lung Transplant Date: 2010-10-29 Impact factor: 10.247
Authors: Nicholas C Dang; Veli K Topkara; Michelle Mercando; Joy Kay; Kurt H Kruger; Michael S Aboodi; Mehmet C Oz; Yoshifumi Naka Journal: J Heart Lung Transplant Date: 2005-12-09 Impact factor: 10.247
Authors: Leslie W Miller; Karl E Nelson; Robin R Bostic; Kuo Tong; Mark S Slaughter; James W Long Journal: J Heart Lung Transplant Date: 2006-07 Impact factor: 10.247
Authors: E A Rose; A J Moskowitz; M Packer; J A Sollano; D L Williams; A R Tierney; D F Heitjan; P Meier; D D Ascheim; R G Levitan; A D Weinberg; L W Stevenson; P A Shapiro; R M Lazar; J T Watson; D J Goldstein; A C Gelijns Journal: Ann Thorac Surg Date: 1999-03 Impact factor: 4.330
Authors: Valentino Piacentino; Matthew L Williams; Tim Depp; Karla Garcia-Huerta; Laura Blue; Andrew J Lodge; G Burkhard Mackensen; Madhav Swaminathan; Joseph G Rogers; Carmelo A Milano Journal: Ann Thorac Surg Date: 2011-04-01 Impact factor: 4.330
Authors: Evgenij V Potapov; Alexander Stepanenko; Michael Dandel; Marian Kukucka; Hans B Lehmkuhl; Yuguo Weng; Felix Hennig; Thomas Krabatsch; Roland Hetzer Journal: J Heart Lung Transplant Date: 2008-12 Impact factor: 10.247
Authors: Mark S Slaughter; Steven S Tsui; Aly El-Banayosy; Benjamin C Sun; Robert L Kormos; Dale K Mueller; H Todd Massey; Timothy B Icenogle; David J Farrar; J Donald Hill Journal: J Thorac Cardiovasc Surg Date: 2007-06 Impact factor: 5.209
Authors: Yaron D Barac; Alina Nicoara; Muath Bishawi; Jacob N Schroder; Mani A Daneshmand; Nazish K Hashmi; Eric Velazquez; Joseph G Rogers; Chetan B Patel; Carmelo A Milano Journal: JACC Heart Fail Date: 2019-12-11 Impact factor: 12.035
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: Evgenij V Potapov; Christiaan Antonides; Maria G Crespo-Leiro; Alain Combes; Gloria Färber; Margaret M Hannan; Marian Kukucka; Nicolaas de Jonge; Antonio Loforte; Lars H Lund; Paul Mohacsi; Michiel Morshuis; Ivan Netuka; Mustafa Özbaran; Federico Pappalardo; Anna Mara Scandroglio; Martin Schweiger; Steven Tsui; Daniel Zimpfer; Finn Gustafsson Journal: Eur J Cardiothorac Surg Date: 2019-08-01 Impact factor: 4.191
Authors: Kevin M Veen; Mostafa M Mokhles; Osama Soliman; Theo M M H de By; Paul Mohacsi; Felix Schoenrath; Lech Paluszkiewicz; Ivan Netuka; Ad J J C Bogers; Johanna J M Takkenberg; Kadir Caliskan Journal: Eur J Cardiothorac Surg Date: 2021-01-04 Impact factor: 4.191
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
Authors: Johanna Mulzer; Hristo Krastev; Christoph Hoermandinger; Alexander Meyer; Thomas Haese; Julia Stein; Marcus Müller; Felix Schoenrath; Christoph Knosalla; Christoph Starck; Volkmar Falk; Evgenij Potapov; Jan Knierim Journal: Ann Cardiothorac Surg Date: 2021-05