title: Tricuspid valve repair with left ventricular assist device implantation: is it warranted?
abstract: BACKGROUND
  Tricuspid regurgitation is common in patients with advanced heart failure. The ideal operative strategy for managing tricuspid valve regurgitation (TR) in patients undergoing left ventricular assist device (LVAD) implantation is unclear. This study was designed to evaluate the effect on outcomes of concomitant tricuspid valve repair (TVR) for moderate to severe (3(+)/4(+)) TR at the time of LVAD implantation.
  
  
  METHODS
  Patients with >3(+) TR who underwent LVAD implantation from 2005 to 2009 were retrospectively evaluated. Pre-, intra- and post-operative data, including hemodynamics, inotrope requirements and end-organ function parameters, were considered. Outcomes of patients receiving TVR were compared with those who did not receive TVR (NTVR).
  
  
  RESULTS
  Seventy-two LVADs were implanted during the study period. Forty-two (58%) patients had ≥ 3(+) TR prior to LVAD implantation. Eight patients underwent TVR and 34 patients did not undergo TVR (NTVR). There were no significant differences in baseline characteristics or severity of TR between the two groups. The TVR group had a longer cardiopulmonary bypass time (p < 0.01) and required more blood products (p < 0.05). Higher post-operative creatinine and blood urea nitrogen (BUN) values were noted in the TVR group. One patient in the TVR group and 3 patients in the NTVR group required right-sided mechanical assistance (p = 0.6). There was no significant difference in short- or long-term mortality between the two groups.
  
  
  CONCLUSIONS
  TVR for ≥ 3(+) TR prolonged operative time and showed similar outcomes compared with LVAD implantation alone. A benefit of performing TVR was not demonstrated. As such, TVR may not be necessary at the time of LVAD implantation.
authors.affiliation: Division of Cardiac Surgery, Center for Heart Failure, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois 60611, USA.
authors.forename: Diyar
authors.initials: D
authors.lastname: Saeed
authors.forename: Trilokesh
authors.initials: T
authors.lastname: Kidambi
authors.forename: Shanaz
authors.initials: S
authors.lastname: Shalli
authors.forename: Brittany
authors.initials: B
authors.lastname: Lapin
authors.forename: S Chris
authors.initials: SC
authors.lastname: Malaisrie
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.forename: William G
authors.initials: WG
authors.lastname: Cotts
authors.forename: Edwin C
authors.initials: EC
authors.lastname: McGee
mesh_terms: D000328:Adult; D000368:Aged; D058385:Cardiac Valve Annuloplasty; D004452:Echocardiography; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*