title: Tricuspid Valve Annular Dilation as a Predictor of Right Ventricular Failure After Implantation of a Left Ventricular Assist Device.
abstract: BACKGROUND
  Tricuspid annular (TA) dilation has been suggested as a more reliable marker of concomitant advanced right ventricular failure (RVF) than severity of tricuspid regurgitation (TR). Our objective was to examine the impact of TA dilation on occurrence of RVF and in-hospital mortality following left ventricular assist device (LVAD) implant.
  
  
  METHODS
  Consecutive patients undergoing implantation of a continuous-flow LVAD implant were grouped according to the presence or absence of preoperative dilated TA. Clinical characteristics, hemodynamics, and short-term postoperative outcomes were compared between groups. RVF was defined as unplanned right ventricular assist device (RVAD) or postoperative use of inotropes for >14 days. Linear and logistic regressions were used to explore associations of TA with occurrence of RVF and duration of inotrope use.
  
  
  RESULTS
  We included 69 patients who had continuous-flow LVAD implanted between 2006 and 2013 (50 ± 13 years old; 69% males; 37% ischemic etiology; 69% bridge-to-transplant LVAD; 18% INTERMACS 1-2; 48% with significant TR). RVF occurred in nine cases, and overall in-hospital mortality rate was 14%. Tricuspid valve repair was performed in ten cases. Dilated TA (OR 4.86; 95% CI 1.05-22.33; p = 0.04) was associated with RVF. In an adjusted multivariable analysis, indexed TA was an independent predictor of increased days of inotrope use (0.8-day increase in inotrope use for every 1 mm/m2 increase; p = 0.04).
  
  
  CONCLUSIONS
  In this cohort, TA dilation was a predictor of RVF after LVAD implant. The potential benefit of concomitant TVR in selected patients with a dilated TA undergoing LVAD implantation remains to be determined.
authors.affiliation: Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Livia
authors.initials: L
authors.lastname: Goldraich
authors.affiliation: Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawajiri
authors.affiliation: Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Farid
authors.initials: F
authors.lastname: Foroutan
authors.affiliation: Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Juarez
authors.initials: J
authors.lastname: Braga
authors.affiliation: Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.|Echocardiography Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Billia
authors.affiliation: Echocardiography Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Misurka
authors.affiliation: Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: William E
authors.initials: WE
authors.lastname: Stansfield
authors.affiliation: Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Terrence
authors.initials: T
authors.lastname: Yau
authors.affiliation: Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Ross
authors.affiliation: Mechanical Circulatory Support Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004108:Dilatation, Pathologic; D005260:Female; D005544:Forecasting; D006333:Heart Failure; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D019919:Prosthesis Implantation; D014261:Tricuspid Valve / Q000473:pathology*