title: Impact of tricuspid valve surgery at the time of left ventricular assist device insertion on postoperative outcomes.
abstract: Tricuspid regurgitation (TR) is common in patients with heart failure undergoing left ventricular assist device (LVAD) implantation. Whether the TR should be surgically managed at the time of LVAD surgery is controversial. We searched SCOPUS, Web of Science, Ovid EMBASE, and Ovid MEDLINE (through May 10, 2014) for randomized controlled trials and observational studies comparing postoperative outcomes in patients treated with LVAD with concomitant tricuspid valve surgery (TVS) compared with LVAD alone. Six observational studies including 3,249 patients compared outcomes following LVAD + TVS versus LVAD. Four studies were single-center and most did not adjust for potential confounders. Addition of TVS prolonged cardiopulmonary bypass times by an average of 31 minutes (three studies, 95% CI 20-42). There was no difference in need for right ventricular assist device (six studies, HR 1.42, 95% CI 0.54-3.76), acute renal failure (four studies, HR 1.07, 95% CI 0.55-2.10), or early mortality (six studies, HR 1.28, 95% CI 0.78-2.08) in patients treated with LVAD + TVS versus LVAD alone. TVS prolongs cardiopulmonary bypass times, but available data demonstrate no significant association with early postoperative outcomes. However, differences in baseline risk of patients treated with TVS versus not limit our ability to draw conclusions.
authors.affiliation: From the *Division of Cardiovascular Diseases and †Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota; and ‡Division of Cardiovascular Surgery, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Dunlay
authors.forename: Salil V
authors.initials: SV
authors.lastname: Deo
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D002315:Cardiopulmonary Bypass; D006333:Heart Failure / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D007902:Length of Stay; D064887:Observational Studies as Topic; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000601:surgery*