title: Clinical impact of concomitant tricuspid valve procedures during left ventricular assist device implantation.
abstract: BACKGROUND
  Almost 50% of patients referred for implantable left ventricular assist device (LVAD) have significant tricuspid regurgitation (TR). Preoperative TR is associated with negative outcomes but the clinical benefit of concomitant tricuspid valve procedures has not been extensively studied.
  
  
  METHODS
  One hundred fifteen patients, undergoing implantable LVADs, were identified as having significant TR by echocardiography prior to their surgical procedure. Patients underwent either LVAD alone (n = 81) versus LVAD plus concomitant tricuspid procedures (n = 34) (29 annuloplasty ring repairs and 5 bioprosthetic replacements.) Preoperative characteristics and hemodynamics, as well as TR severity and clinical outcomes were retrospectively determined from chart and database review and compared for the two groups.
  
  
  RESULTS
  Preoperative characteristics and hemodynamics were similar for the two groups. Postoperative TR was markedly reduced for the group undergoing concomitant procedures versus LVAD alone. A temporary right ventricular assist device was required for only one of the 34 cases in which concomitant tricuspid procedures were performed; for patients undergoing LVAD alone, 8 of 81 required right ventricular assist devices. Mean duration of postoperative inotrope utilization was increased for the LVAD alone group versus the group with concomitant tricuspid procedures (10.0 vs 8.0 days, respectively, p = 0.04). The incidence of postoperative renal dysfunction was increased for the LVAD alone group (39%) versus concomitant procedures (21%) (p = 0.05). The LVAD alone group also had a greater mean postimplant length of hospitalization versus the concomitant procedures group (26.0 vs 19.0 days, p = 0.02). Finally, there was a trend toward improved survival for the group with concomitant tricuspid procedures versus LVAD alone.
  
  
  CONCLUSIONS
  For patients with significant TR undergoing implantable LVAD procedures, concomitant tricuspid procedures are associated with improved early clinical outcomes.
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: Valentino
authors.initials: V
authors.lastname: Piacentino
authors.forename: Constantine D
authors.initials: CD
authors.lastname: Troupes
authors.forename: Asvin M
authors.initials: AM
authors.lastname: Ganapathi
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Blue
authors.forename: G Burkhard
authors.initials: GB
authors.lastname: Mackensen
authors.forename: Madhav
authors.initials: M
authors.lastname: Swaminathan
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: Mark
authors.initials: M
authors.lastname: Stafford-Smith
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lodge
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
authors.forename: Carmelo A
authors.initials: CA
authors.lastname: Milano
mesh_terms: D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left