ORIGINAL CLINICAL SCIENCE
Tricuspid valve repair with left ventricular assist device
implantation: Is it warranted?
Diyar Saeed, MD,
a
Trilokesh Kidambi,
a
Shanaz Shalli, MD,
a
Brittany Lapin, MPH,
a
S. Chris Malaisrie, MD,
a
Richard Lee, MD, MBA,
a
William G. Cotts, MD,
b
and Edwin C. McGee, Jr., MD
a
From the
a
Division of Cardiac Surgery, and
b
Division of Cardiology, Center for Heart Failure, Bluhm Cardiovascular Institute,
Northwestern Memorial Hospital, Chicago, Illinois.
BACKGROUND: Tricuspid regurgitation is common in patients with advanced heart failure. The ideal
operative strategy for managing tricuspid valve regurgitation (TR) in patients undergoing left ventricular
assist device (LVAD) implantation is unclear. This study was designed to evaluate the effect on outcomes
of concomitant tricuspid valve repair (TVR) for moderate to severe (3
+
/4
+
) TR at the time of LVAD
implantation.
METHODS: Patients with 3
+
TR who underwent LVAD implantation from 2005 to 2009 were
retrospectively evaluated. Pre-, intra- and post-operative data, including hemodynamics, inotrope
requirements and end-organ function parameters, were considered. Outcomes of patients receiving
TVR were compared with those who did not receive TVR (NTVR).
RESULTS: Seventy-two LVADs were implanted during the study period. Forty-two (58%) patients had
3
+
TR prior to LVAD implantation. Eight patients underwent TVR and 34 patients did not undergo
TVR (NTVR). There were no significant differences in baseline characteristics or severity of TR
between the two groups. The TVR group had a longer cardiopulmonary bypass time (p 0.01) and
required more blood products (p 0.05). Higher post-operative creatinine and blood urea nitrogen
(BUN) values were noted in the TVR group. One patient in the TVR group and 3 patients in the NTVR
group required right-sided mechanical assistance (p = 0.6). There was no significant difference in short-
or long-term mortality between the two groups.
CONCLUSIONS: TVR for 3
+
TR prolonged operative time and showed similar outcomes compared
with LVAD implantation alone. A benefit of performing TVR was not demonstrated. As such, TVR
may not be necessary at the time of LVAD implantation.
J Heart Lung Transplant 2011;30:530 –5
© 2011 International Society for Heart and Lung Transplantation. All rights reserved.
KEYWORDS:
heart failure;
ventricular assist
device;
right heart failure;
tricuspid regurgitation
The beneficial effect of left ventricular assist device
(LVAD) implantation for patients with end-stage heart fail-
ure as bridge to transplantation, destination therapy and
myocardial recovery has been clearly demonstrated.
1–3
However, up to 30% of LVAD patients may eventually
require a right ventricular assist device (RVAD) and/or
prolonged inotropic support due to right ventricular failure.
4
Significant tricuspid valve regurgitation (TR) is fre-
quently encountered in the population of patients undergo-
ing LVAD. There is a paucity of data regarding the optimal
management of these patients. Some groups have refrained
from performing concomitant procedures at the time of
LVAD implantation to shorten cardiopulmonary bypass
(CPB) time.
5
Conversely, other groups perform tricuspid
valve repair (TVR) as an adjunct in the prevention of right
ventricular (RV) failure.
6
The objective of this study was to
evaluate the effect of performing concomitant TVR for
moderate to severe (3
+
/4
+
) TR at the time of LVAD
implantation.
Reprint requests: Edwin C. McGee, Jr., MD, Division of Cardiac Surgery,
Northwestern Memorial Hospital, 201 East Huron Street, Galter Pavilion
11-140, Chicago, IL 60611. Telephone: 312-695-0454. Fax: 312-695-1903.
E-mail address: emcgee@nmh.org
http://www.jhltonline.org
1053-2498/$ -see front matter © 2011 International Society for Heart and Lung Transplantation. All rights reserved.
doi:10.1016/j.healun.2010.12.002