title: Utility of concomitant tricuspid valve procedures for patients undergoing implantation of a continuous-flow left ventricular device.
abstract: OBJECTIVE
  Patients referred for implantable continuous-flow left ventricular assist devices (cfLVAD) frequently have preoperative right heart failure and tricuspid regurgitation (TR). The objective of this report is to examine early clinical benefits of concomitant tricuspid surgery for these patients.
  
  
  METHODS
  Sixty-one of 200 consecutive cfLVAD patients at our institution displayed preimplant right heart dysfunction and significant TR. Thirty-three underwent cfLVAD plus a tricuspid valve procedure (TVP), and 28 had cfLVAD alone. Preimplant characteristics and clinical outcomes were retrospectively studied. As previously described, post-LVAD right ventricular failure was defined as need for right ventricular assist device (RVAD) support or greater than 14 days of intravenous inotropic support.
  
  
  RESULTS
  Preimplant characteristics were similar between the 2 groups. Cardiopulmonary bypass time was increased for the group that received concomitant TVPs. The most common TVP consisted of an undersizing ring annuloplasty. The cfLVAD-alone group had greater TR after implant relative to the cfLVAD+TVP group. The cfLVAD-alone group experienced greater postprocedure right ventricular failure relative to cfLVAD+TVP (46.4% vs 18.2%; P < .05). Furthermore, prolonged hospitalization was increased for the cfLVAD-alone group versus the cfLVAD+TVP. Survival was similar between the 2 groups.
  
  
  CONCLUSIONS
  Concomitant TVP appears to reduce postprocedure right ventricular failure for patients with significant TR undergoing cfLVAD implantation.
authors.affiliation: Division of Cardiac and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Valentino
authors.initials: V
authors.lastname: Piacentino
authors.forename: Asvin M
authors.initials: AM
authors.lastname: Ganapathi
authors.forename: Mark
authors.initials: M
authors.lastname: Stafford-Smith
authors.forename: Michael K
authors.initials: MK
authors.lastname: Hsieh
authors.forename: Chetan B
authors.initials: CB
authors.lastname: Patel
authors.forename: Alan A
authors.initials: AA
authors.lastname: Simeone
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
authors.forename: Carmelo A
authors.initials: CA
authors.lastname: Milano
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D058385:Cardiac Valve Annuloplasty; D002315:Cardiopulmonary Bypass; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006353:Heart-Assist Devices; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011474:Prosthesis Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right