Author + information
- Received April 15, 2019
- Revision received July 3, 2019
- Accepted August 16, 2019
- Published online January 27, 2020.
- Yaron D. Barac, MD, PhDa,∗∗ (, )
- Alina Nicoara, MDb,∗,
- Muath Bishawi, MDa,
- Jacob N. Schroder, MDa,
- Mani A. Daneshmand, MDa,
- Nazish K. Hashmi, MBBSb,
- Eric Velazquez, MDc,
- Joseph G. Rogers, MDc,
- Chetan B. Patel, MDc and
- Carmelo A. Milano, MDa
- aDivision of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
- bDivision of Cardiothoracic Anesthesiology, Duke University Medical Center, Durham, North Carolina
- cDivision of Cardiology, Duke University Medical Center, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. Yaron D. Barac, Duke University Medical Center, 10 Duke Medicine Circle, Durham, North Carolina 27710.
Objectives This study sought to determine the durability of tricuspid valve repair (TVr) performed concurrently with left ventricular assist device (LVAD) implantation and its association with the development of late right heart failure (RHF).
Background Surgical management of tricuspid regurgitation (TR) at the time of LVAD implantation is performed in an attempt to reduce the occurrence of postoperative RHF. Limited data exist regarding the durability of TVr in patients with LVAD as well as its impact on development of late RHF.
Methods A retrospective review was conducted of consecutive adult patients who underwent durable LVAD implantation and concurrent TVr at the authors’ institution between 2009 and 2017. Late RHF was defined as readmission for HF requiring inotropic or diuretic therapy. TVr failure was defined as moderate or severe TR at any follow-up echocardiographic examination after LVAD implantation.
Results A total of 156 patients underwent LVAD and concurrent TVr during the study. Of the total, 59 patients (37.8%) had a failed TVr. The mean duration of echocardiographic follow-up was 23 ± 22 months. Of the 146 patients who were discharged after the index hospitalization, 53 patients (36.3%) developed late RHF. Multivariate Cox proportional hazard analysis demonstrated that TVr failure was an independent predictor of late RHF development (hazard ratio: 2.62; 95% confidence interval: 1.38 to 4.96; p = 0.003).
Conclusions Failure of TVr in this cohort occurred at a significant rate. Failure of TVr is an independent risk factor for development of late RHF. Future studies should investigate strategies to reduce recurrence of significant TR.
↵∗ Drs. Barac and Nicoara contributed equally to this work.
Supported by U.S. National Heart, Lung, and Blood Institute grant 1R38HL143612-01 (to Dr. Bishawi). Drs. Milano and Bishawi have received research support from Abbott and Medtronic. Dr. Daneshmand serves on the medical advisory board of Fresenius. Dr. Nicoara is a consultant for Abbott. Dr. Velazquez has received research support from and is a consultant for Novartis. Dr. Patel is a consultant for Abbott Labs. Dr. Milano is a consultant for Abbott Labs and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. John Teerlink, MD, served as Guest Editor for this paper.
This paper was presented in part at the 2018 Annual Meeting of the American Heart Association on November, 10-14, 2018, in Chicago, Illinois.
- Received April 15, 2019.
- Revision received July 3, 2019.
- Accepted August 16, 2019.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.