title: Impact of tricuspid valve regurgitation in patients treated with implantable left ventricular assist devices.
abstract: BACKGROUND
  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.
  
  
  METHODS
  One 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.
  
  
  RESULTS
  Relative 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).
  
  
  CONCLUSIONS
  Tricuspid regurgitation is not reduced immediately after LVAD implantation. Significant TR is associated with longer postimplant inotropic support and length of hospital stay.
authors: Division of Cardiac and Thoracic Surgery, Department of Cardiac and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors: Valentino
authors: V
authors: Piacentino
authors: Matthew L
authors: ML
authors: Williams
authors: Tim
authors: T
authors: Depp
authors: Karla
authors: K
authors: Garcia-Huerta
authors: Laura
authors: L
authors: Blue
authors: Andrew J
authors: AJ
authors: Lodge
authors: G Burkhard
authors: GB
authors: Mackensen
authors: Madhav
authors: M
authors: Swaminathan
authors: Joseph G
authors: JG
authors: Rogers
authors: Carmelo A
authors: CA
authors: Milano
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D006353:Heart-Assist Devices; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*