Kevin M Veen1, Kadir Caliskan2, Theo M M H de By3, Mostafa M Mokhles1, Osama I Soliman2, Paul Mohacsi4, Felix Schoenrath5,6, Jan Gummert7, Lech Paluszkiewicz7, Ivan Netuka8,9, Antonio Loforte10, Yuriy Pya11, Johanna J M Takkenberg1, Ad J J C Bogers1. 1. Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands. 2. Department of Cardiology, Erasmus MC, Rotterdam, Netherlands. 3. EUROMACS Registry, EACTS, Windsor, UK. 4. Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 5. Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. 6. DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany. 7. Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. 8. Department of Cardiothoracic Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. 9. Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. 10. Cardiac Surgery Unit, Policlinico di S. Orsola, Bologna, Italy. 11. National Research Cardiac Surgery Center, Astana, Kazakhstan.
Abstract
OBJECTIVES: Tricuspid regurgitation (TR) is common in patients receiving a left ventricular assist device (LVAD). Controversy exists as to whether concomitant tricuspid valve surgery (TVS) is beneficial in currently treated patients. Therefore, our goal was to investigate the effect of TVS concomitant with a LVAD implant. METHODS: The European Registry for Patients with Mechanical Circulatory Support was used to identify adult patients. Matched patients with and without concomitant TVS were compared using a propensity score matching strategy. RESULTS: In total, 3323 patients underwent LVAD implantation of which 299 (9%) had TVS. After matching, 258 patients without TVS were matched to 258 patients with TVS. In the matched population, hospital deaths, days on inotropic support, temporary right ventricular assist device implants and hospital stay were comparable, whereas stay in the intensive care unit was higher in the TVS cohort (11 vs 15 days; P = 0.026). Late deaths (P = 0.17), cumulative incidence of unexpected hospital readmission (P = 0.15) and right heart failure (P = 0.55) were comparable between patients with and without concomitant TVS. In the matched population, probability of moderate-to-severe TR immediately after surgery was lower in patients with concomitant TVS compared to patients without TVS (33% vs 70%; P = 0.001). Nevertheless, the probability of moderate-to-severe TR decreased more quickly in patients without TVS (P = 0.030), resulting in comparable probabilities of moderate-to-severe TR within 1.5 years of follow-up. CONCLUSIONS: In matched patients, TVS concomitant with LVAD implant does not seem to be associated with better clinical outcomes. Concomitant TVS reduced TR significantly early after LVAD implant; however, differences in probability of TR disappeared during the follow-up period.
OBJECTIVES:Tricuspid regurgitation (TR) is common in patients receiving a left ventricular assist device (LVAD). Controversy exists as to whether concomitant tricuspid valve surgery (TVS) is beneficial in currently treated patients. Therefore, our goal was to investigate the effect of TVS concomitant with a LVAD implant. METHODS: The European Registry for Patients with Mechanical Circulatory Support was used to identify adult patients. Matched patients with and without concomitant TVS were compared using a propensity score matching strategy. RESULTS: In total, 3323 patients underwent LVAD implantation of which 299 (9%) had TVS. After matching, 258 patients without TVS were matched to 258 patients with TVS. In the matched population, hospital deaths, days on inotropic support, temporary right ventricular assist device implants and hospital stay were comparable, whereas stay in the intensive care unit was higher in the TVS cohort (11 vs 15 days; P = 0.026). Late deaths (P = 0.17), cumulative incidence of unexpected hospital readmission (P = 0.15) and right heart failure (P = 0.55) were comparable between patients with and without concomitant TVS. In the matched population, probability of moderate-to-severe TR immediately after surgery was lower in patients with concomitant TVS compared to patients without TVS (33% vs 70%; P = 0.001). Nevertheless, the probability of moderate-to-severe TR decreased more quickly in patients without TVS (P = 0.030), resulting in comparable probabilities of moderate-to-severe TR within 1.5 years of follow-up. CONCLUSIONS: In matched patients, TVS concomitant with LVAD implant does not seem to be associated with better clinical outcomes. Concomitant TVS reduced TR significantly early after LVAD implant; however, differences in probability of TR disappeared during the follow-up period.
Authors: Julia Riebandt; Anne Schaefer; Dominik Wiedemann; Thomas Schlöglhofer; Günther Laufer; Sigrid Sandner; Daniel Zimpfer Journal: Ann Cardiothorac Surg Date: 2021-03
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