title: Concomitant tricuspid valve repair or replacement during left ventricular assist device implant demonstrates comparable outcomes in the long term.
abstract: BACKGROUND
  Severe tricuspid regurgitation (TR) is present in nearly half the patients undergoing implant of a left ventricular assist device (LVAD) and its correction confers better long-term outcome.
  
  
  OBJECTIVE
  To compare the early and late results of tricuspid valve repair (TVrpr) or replacement (TVR) with LVAD implant.
  
  
  METHODS
  Sixty-four from a cohort of 126 patients had a concomitant tricuspid valve procedure; 48 (75%) underwent a TVrpr whereas 16 (25%) had TVR. All preoperative hemodynamic parameters including the mean TR grade (TVrpr; 3.6 vs. TVR; 3.7) were comparable (p = 0.7). The mean TR grade was 1.6 ± 1.5 for the remaining 62 patients who did not have a concomitant tricuspid valve procedure, with 4/62 (6%) having severe TR (p < 0.0001).
  
  
  RESULTS
  Cardiopulmonary bypass time was longer for patients undergoing TVR (p = 0.01). There was a significant reduction in right atrial pressure for the entire cohort (p < 0.01) and the postoperative right atrial pressure was not statistically different between TVrpr (13.6 ± 4.6) and TVR (11.6 ± 4.3; p = 0.6. Postoperative intensive care unit stay was comparable as was the duration of inotropic support (p = 0.5) or need for temporary right ventricular mechanical support. In-hospital mortality (12%) was not different between groups. The mean time for LVAD support was 12.3 ± 9.71 months and the last transthoracic echocardiographic examination was performed at mean intervals of 13.8 ± 10.8 months (TVrpr) and 11.8 ± 7.6 months (TVR; p = 0.47). Reduction in TR grade was similar between groups (p = 0.27). Late mortality (p = 1.00) was comparable in both groups. Using log-rank analysis, there was no significant difference in the estimated survival between TVrpr and TVR (p = 0.88).
  
  
  CONCLUSIONS
  TVrpr repair at the time of LVAD implant is effective in correcting TR even at the end of one year of follow-up. The choice to repair or replace does not affect the clinical outcome.
authors.affiliation: Department of Cardiovascular Surgery Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota 55901, USA.
authors.forename: Salil V
authors.initials: SV
authors.lastname: Deo
authors.forename: Tal
authors.initials: T
authors.lastname: Hasin
authors.forename: Salah E
authors.initials: SE
authors.lastname: Altarabsheh
authors.forename: Stephen H
authors.initials: SH
authors.lastname: McKellar
authors.forename: Ishan K
authors.initials: IK
authors.lastname: Shah
authors.forename: Lucian
authors.initials: L
authors.lastname: Durham
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
authors.forename: Lyle D
authors.initials: LD
authors.lastname: Joyce
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000601:surgery*