title: Durability and clinical impact of tricuspid valve procedures in patients receiving a continuous-flow left ventricular assist device.
abstract: OBJECTIVE
  Patients evaluated for a continuous-flow left ventricular assist device frequently present with severe right ventricular dysfunction with tricuspid regurgitation. Long-term outcomes of concurrent tricuspid valve procedures in continuous-flow left ventricular assist device implantation are unclear.
  
  
  METHODS
  From May 2004 to December 2013, 336 patients received continuous-flow left ventricular assist devices. Among these, 8 patients with prior tricuspid valve procedures were excluded. At continuous-flow left ventricular assist device implantation, 76 patients underwent tricuspid valve procedures (group A), including 68 repairs and 8 replacements. The remaining 252 patients did not receive concurrent tricuspid valve procedures (group B).
  
  
  RESULTS
  Preoperatively, group A had higher central venous pressure/pulmonary capillary wedge pressure (P = .032), total bilirubin (P = .009), and percentage of moderate or greater tricuspid regurgitation (98.7% vs 18.8%; P < .001). In group A, cardiopulmonary bypass time (136 ± 52.0 minutes vs 83.9 ± 38.8 minutes; P < .001), intraoperative platelet use (13.6 ± 6.70 units vs 11.7 ± 5.92 units; P = .042), and bleeding requiring reoperation (27.5% vs 16.7%; P = .046) were significantly increased. In-hospital mortality was similar (10.5% vs 6.4%; P = .22). On-device 2-year survival was 73.9% in group A and 74.2% in group B (P = .24). At 2 years, mean cumulative readmissions for right heart failure was 0.21 in group A and 0.27 in group B (P = .95). A generalized linear mixed-effects model showed that tricuspid valve procedures are protective for developing future significant tricuspid regurgitation (odds ratio, 0.38; 95% confidence interval, 0.19-0.76; P = .006).
  
  
  CONCLUSIONS
  Concomitant tricuspid valve procedures at continuous-flow left ventricular assist device implantation can be performed safely and are protective against worsening tricuspid regurgitation during the first 2 years of support.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Jiho
authors.initials: J
authors.lastname: Han
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kurlansky
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Mauro
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY.
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY.
authors.forename: Melana
authors.initials: M
authors.lastname: Yuzefpolskaya
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Fukuhara
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Truby
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY.
authors.forename: Veli K
authors.initials: VK
authors.lastname: Topkara
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY.
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Garan
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY. Electronic address: yn33@columbia.edu.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
mesh_terms: D000328:Adult; D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: right heart failure; tricuspid valve; ventricular assist device