Liberal use of tricuspid-valve annuloplasty during left-ventricular assist device implantation

• Published in: European journal of cardio-thoracic surgery 2012-01, Vol.41 (1), p.213-217
• Main Authors: Krishan, Kewal, Nair, Ajith, Pinney, Sean, Adams, David H., Anyanwu, Anelechi C.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac Valve Annuloplasty - adverse effects; Cardiac Valve Annuloplasty - methods; Cardiology. Vascular system; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Endocardial and cardiac valvular diseases; Female; Heart; Heart Failure - complications; Heart Failure - physiopathology; Heart Failure - surgery; Heart-Assist Devices; Hemodynamics - physiology; Humans; Intensive care medicine; Length of Stay - statistics & numerical data; Male; Medical sciences; Middle Aged; Pneumology; Postoperative Care - methods; Prosthesis Implantation - methods; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Tricuspid Valve - surgery; Tricuspid Valve Insufficiency - etiology; Tricuspid Valve Insufficiency - surgery; Tx & Mcs
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2011.05.047

OBJECTIVE The study aimed to determine whether liberal use of tricuspid-valve repair (TVr) is associated with adverse outcomes. METHODS The study was a retrospective review of 51 implantable left-ventricular assist devices (LVADs) performed in a single center between January 2008 and December 2009. TVr using Edwards MC 3 annuloplasty ring was performed if there was either documented moderate or greater tricuspid regurgitation or severe annular dilatation. RESULTS TVr was performed in 37 patients. One patient was converted to replacement intra-operatively. Compared with patients who did not have TVr, the age was similar (mean 52 vs 50 years, p = 0.62), as was frequency of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 1 or 2 (43% vs 50%, p = 0.13). Day 1 hemodynamics were also similar: mean central venous pressure (13.5 vs 14 mmHg; p = 0.10) and mean pulmonary artery pressure (25 vs 25.6 mmHg; p = 0.76), as was Day 1 bilirubin (3.1 vs 3.9 mg dl−1, p = 0.27). Median duration of mechanical ventilation (2 days) and inotropic support (5 days) and rates of bleeding were identical in both groups. Although there was a trend toward longer intensive care unit (ICU) stays in the TVr group (6 vs 5 days; p = 0.12), as a group these patients experienced less use of blood-product transfusion and less hospital length of stay. Hospital mortality was similar in both groups (TVr 18.9%, no TVr 21.4%, p = 0.7). CONCLUSIONS TVr can be applied during LVAD implantation without 'obvious' increase in perioperative risk. As there are theoretical benefits to eliminating tricuspid regurgitation, our data argue for a more liberal approach to TVr at the time of LVAD implantation.