title: Right heart failure and benefits of adjuvant tricuspid valve repair in patients undergoing left ventricular assist device implantation.
abstract: OBJECTIVE
  Although right heart failure (RVF) is an important issue in the management of patients with left ventricular assist devices (LVADs), the benefits of performing tricuspid valve repair in conjunction with LVAD implantation have not been demonstrated.
  
  
  METHODS
  We retrospectively reviewed the records of 141 patients who received LVAD implantation as a bridge to transplant from May 1999 to January 2013. We assessed short- and long-term right heart function in 69 of these patients who underwent tricuspid valve repair because of moderate-to-severe tricuspid regurgitation (TR) or severe dilatation of the tricuspid annulus. RVF was defined as the need for a right ventricular assist device or >30 days of intravenous inotropic support. TR was graded from 0 to 4, while fibrosis in myocardial biopsy samples was graded pathologically from 0 to 3.
  
  
  RESULTS
  The average duration of LVAD support was 595 days. Twenty-seven patients developed RVF and their survival rate was significantly worse than that of patients who did not develop RVF (65 vs 91% at 1 year). RVF was significantly related to high preoperative ratio of central venous pressure (CVP) to pulmonary capillary wedge pressure, high total bilirubin, high fibrosis score and high TR grade. In patients who underwent tricuspid valve repair, the TR grade was significantly reduced from 2.6 to 1.0, and this decrease was maintained for 2 years. Although patients who underwent tricuspid valve repair had significantly higher TR grades, ratios of CVP to pulmonary capillary wedge pressure and fibrosis scores preoperatively, no survival impairment was seen.
  
  
  CONCLUSIONS
  Tricuspid valve repair is a useful and durable adjuvant procedure for restoring deteriorated right ventricular function in patients requiring LVAD implantation.
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Centre, Osaka, Japan tomofujita@nifty.com tfujita@hsp.ncvc.go.jp.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hata
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Seguchi
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Murata
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yanase
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Centre, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatani
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000453:epidemiology / Q000601:surgery*
keywords: Left ventricular assist device; Right heart failure; Tricuspid valve repair