1. Impact of tricuspid valve regurgitation in patients treated with implantable left ventricular assist devices.
- Author
-
Piacentino V 3rd, Williams ML, Depp T, Garcia-Huerta K, Blue L, Lodge AJ, Mackensen GB, Swaminathan M, Rogers JG, and Milano CA
- Subjects
- Adult, Aged, Cohort Studies, Echocardiography, Doppler, Female, Follow-Up Studies, Heart Failure complications, Heart Failure diagnostic imaging, Hospital Mortality trends, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Postoperative Care, Postoperative Complications mortality, Postoperative Complications physiopathology, Preoperative Care methods, Retrospective Studies, Risk Assessment, Severity of Illness Index, Statistics, Nonparametric, Survival Analysis, Treatment Outcome, Tricuspid Valve Insufficiency complications, Tricuspid Valve Insufficiency diagnostic imaging, Heart Failure mortality, Heart Failure surgery, Heart-Assist Devices, Tricuspid Valve Insufficiency mortality, Tricuspid Valve Insufficiency surgery
- Abstract
Background: The progression of tricuspid valve regurgitation (TR) and the impact of preoperative TR on postoperative outcomes in patients having left ventricular assist device (LVAD) implantation has not been studied., Methods: One hundred seventy-six consecutive implantable LVAD procedures were retrospectively reviewed. A total of 137 patients comprised the final study group with complete preimplant characteristics, before and after echocardiogram assessment of TR, and outcomes data. Patients were divided into two groups: insignificant TR (iTR) consisting of those with preimplant TR grades of none, trace, and mild; and significant TR (sTR) consisting of those with moderate and severe TR grades., Results: Relative to patients with iTR, patients with sTR were younger (53.6±12.8 versus 58.4±10.0 years, p=0.02) and more commonly had nonischemic cardiomyopathies (69% versus 38%, p<0.001). The preimplant incidence of iTR and sTR was 51% and 49%. Immediately after the LVAD implant procedure, TR did not significantly change. At late follow-up (156±272 days), 32% had moderate or severe TR. Also, 41% of the original sTR group persisted with moderate or severe TR. Relative to patients with iTR, patients with sTR required longer postimplant intravenous inotropic support (8.5 versus 5.0 days, p=0.02), more commonly required a temporary right ventricular assist device, and had a longer postimplant length of hospital stay (27.0 versus 20.0 days, p=0.03). There was also a trend toward decreased survival for sTR versus iTR (log rank=0.05)., Conclusions: Tricuspid regurgitation is not reduced immediately after LVAD implantation. Significant TR is associated with longer postimplant inotropic support and length of hospital stay., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF