title: Limited Utility of Tricuspid Valve Repair at the Time of Left Ventricular Assist Device Implantation.
abstract: BACKGROUND
  The optimal management of tricuspid regurgitation (TR) in patients undergoing left ventricular assist device (LVAD) implantation is controversial. This study was undertaken to determine the impact of tricuspid valve repair (TVR) at the time of LVAD implantation on survival.
  
  
  METHODS
  The Interagency Registry for Mechanically Assisted Circulatory Support was used to analyze the outcomes of patients undergoing LVAD implantation as destination therapy with or without concomitant TVR.
  
  
  RESULTS
  Among 2,527 patients undergoing implant of a continuous flow LVAD as destination therapy during the study period, 989 (39%) had moderate or severe TR. The management of TR was not uniform among these patients. Patients with moderate and severe TR underwent TVR in 16.7% and 35.3% of cases, respectively. Moderate and severe TR at the time of LVAD implantation were associated with poorer survival over the entire follow-up period (p = 0.009). Interestingly, TVR at the time of LVAD implantation did not confer improved survival, even among patients with preimplant moderate or severe TR. A potential explanation for this finding is that patients with preimplant moderate or severe TR who underwent LVAD implant with concomitant TVR commonly experienced recurrent, late TR (21% to 27%).
  
  
  CONCLUSIONS
  Tricuspid valve repair is performed commonly at the time of LVAD implant despite the fact that it does not confer a clear survival benefit. For many patients, LVAD implant alone relieves preimplant TR as effectively as LVAD implant with TVR. Further study is necessary to determine what factors lead to recurrence of late TR in LVAD patients both with and without TVR.
authors.affiliation: Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Oregon. Electronic address: songh@ohsu.edu.
authors.forename: Howard K
authors.initials: HK
authors.lastname: Song
authors.affiliation: Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Gelow
authors.affiliation: Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: James
authors.initials: J
authors.lastname: Mudd
authors.affiliation: Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Christopher
authors.initials: C
authors.lastname: Chien
authors.affiliation: Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Oregon.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Tibayan
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hollifield
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: David
authors.initials: D
authors.lastname: Naftel
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: James
authors.initials: J
authors.lastname: Kirklin
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality*; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*