Impact of Tricuspid Valve Regurgitation in Patients Treated With Implantable Left Ventricular Assist Devices

摘要

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.MethodsOne 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.ResultsRelative 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).ConclusionsTricuspid regurgitation is not reduced immediately after LVAD implantation. Significant TR is associated with longer postimplant inotropic support and length of hospital stay.CTSNet classification:27, 35Drs Rogers and Milano disclose that they have financial relationships with Thoratec Corporation.Implantable left ventricular assist devices (LVADs) have become a more common treatment for patients with end-stage heart failure as either bridge to cardiac transplantation or permanent therapy. Newer LVADs, featuring continuous flow with either axial or centrifugal designs, have been shown to be more durable, but morbidity remains significant [