Purpose Right ventricular (RV) failure is associated with significant post-operative morbidity and mortality after left ventricular assist device (LVAD) insertion. Concomitant tricuspid valve repair (TVR) in the setting of tricuspid regurgitation (TR) is frequently performed to improve RV function after LVAD insertion. This study compared outcomes of patients with TR after LVAD insertion with and without TVR.
Methods This was a retrospective case control study of 70 patients with matched degrees of TR undergoing LVAD implantation from 2000 to 2006 (Heartmate1, Heartmate2, DeBakey MicroMed). The TVR group consisted of patients undergoing LVAD insertion with TVR (n=24). The control group consisted of patients undergoing LVAD insertion without TVR (n=46). TR was quantified as 0 (none) to 4+ (severe) on echocardiography preoperatively and postoperatively. RV dysfunction score was defined as 0 (none), 1 (mild), 2 (moderate), or 3 (severe) on echocardiography. Postoperative clinical parameters, complications, and outcomes were evaluated.
Results The TVR group and control group were similar in age (55y±15 vs 53y±12 respectively), gender distribution (18/24 male vs 42/46 male), ejection fraction (16%±5 vs 16%±6), LVAD score (preoperative measure of risk assessment 0–10), TR, mean PAP, CVP, and peak RV systolic pressure. In the TVR group, TR decreased from 2.0±0.8 to 0.7±0.5 post-operatively (p<0.001). In the control group, TR also decreased from 2.2±0.7 to 1.3±0.8 (p<0.001). In the TVR group, RV dysfunction score fell from 2.1±0.6 to 1.4±1.0 (p=0.01). In the control group, RV dysfunction score fell from 2.1±0.8 to 0.8±1.1 (p=0.049). Bypass time was higher in the TVR group (124±33min vs 66±46min). Incidence of acute renal failure (ARF) was lower in the TVR group (OR 0.2, p=0.02). There were no differences between the two groups regarding need for post-operative RVAD, early extubation, ICU LOS, bridge to transplant rate, or 30 day mortality.
Conclusion Patients with TR requiring LVAD insertion had no improved survival when TVR was performed simultaneously. Bypass time was prolonged when TVR was performed. Patient groups with and without TVR had similar decreases in TR and improvement in RV dysfunction. Incidence of ARF was lower in the TVR group.
Tricuspid valve repair in patients with left-ventricular assist device implants and tricuspid valve regurgitation: propensity score-adjusted analysis of clinical outcome
