Limited Utility of Tricuspid Valve Repair at the Time of Left Ventricular Assist Device Implantation

Howard Song, Jill Gelow, James Mudd, Christopher Chien, Frederick (Fred) Tibayan, Kathryn Hollifield, David Naftel, James Kirklin

Research output: Contribution to journalArticle

20 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2168-2175
Number of pages8
JournalAnnals of Thoracic Surgery
Volume101
Issue number6
DOIs
StatePublished - Jun 1 2016

Fingerprint

Heart-Assist Devices
Tricuspid Valve
Tricuspid Valve Insufficiency
Survival
Registries

ASJC Scopus subject areas

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

Cite this

Limited Utility of Tricuspid Valve Repair at the Time of Left Ventricular Assist Device Implantation. / Song, Howard; Gelow, Jill; Mudd, James; Chien, Christopher; Tibayan, Frederick (Fred); Hollifield, Kathryn; Naftel, David; Kirklin, James.

In: Annals of Thoracic Surgery, Vol. 101, No. 6, 01.06.2016, p. 2168-2175.

Research output: Contribution to journalArticle

@article{40e38e1495384261b141f71a681bc233,
title = "Limited Utility of Tricuspid Valve Repair at the Time of Left Ventricular Assist Device Implantation",
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.",
author = "Howard Song and Jill Gelow and James Mudd and Christopher Chien and Tibayan, {Frederick (Fred)} and Kathryn Hollifield and David Naftel and James Kirklin",
year = "2016",
month = "6",
day = "1",
doi = "10.1016/j.athoracsur.2016.03.040",
language = "English (US)",
volume = "101",
pages = "2168--2175",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "6",

}

TY - JOUR

T1 - Limited Utility of Tricuspid Valve Repair at the Time of Left Ventricular Assist Device Implantation

AU - Song, Howard

AU - Gelow, Jill

AU - Mudd, James

AU - Chien, Christopher

AU - Tibayan, Frederick (Fred)

AU - Hollifield, Kathryn

AU - Naftel, David

AU - Kirklin, James

PY - 2016/6/1

Y1 - 2016/6/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84969776846&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84969776846&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2016.03.040

DO - 10.1016/j.athoracsur.2016.03.040

M3 - Article

C2 - 27139368

AN - SCOPUS:84969776846

VL - 101

SP - 2168

EP - 2175

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 6

ER -