Tricuspid valve repair in patients with left-ventricular assist device implants and tricuspid valve regurgitation: propensity score-adjusted analysis of clinical outcome

Oezpeker, Cenk; Zittermann, Armin; Paluszkiewicz, Lech; Piran, Misagh; Puehler, Thomas; Sayin, Ali; Ensminger, Stephan; Milting, Hendrik; Morshuis, Michiel; Gummert, Jan

doi:10.1093/icvts/ivv260

Cited by 20 publications

(7 citation statements)

References 18 publications

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“…Recently, mostly single-center studies have come to disparate conclusions. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 Saeed and colleagues 9 conducted a retrospective analysis of patients undergoing LVAD implantation with or without TVR. The main finding of this study was that TVR led to prolonged CPB time and greater requirements of blood products, thus concluding that omitting TVR is reasonable in VAD candidates.…”

Section: Resultsmentioning

confidence: 99%

“… 8 However, recent studies regarding treatment and outcome of TVI in patients with LVAD provide diverging results. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 Therefore, surgical approach varies among surgeons, and a consistent treatment strategy according to guidelines is missing. The aim of this study was to examine the direct impact of acute TVI at the time of LVAD implantation on the hemodynamic and LVAD parameters using an acute ovine model with stabile left-sided HF and preserved right ventricular (RV) function.…”

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confidence: 99%

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Impact of tricuspid valve insufficiency on the performance of left ventricular assist devices

et al. 2020

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Impact of tricuspid valve insufficiency on the performance of left ventricular assist devices

et al. 2020

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“…Until now the optimal operative strategy for managing TR in patients undergoing LVAD implantation is still under discussion. Performing a concomitant tricuspid valve replacement or repair in continuous‐flow LVAD patients with moderate to severe TR is controversial . Some published data demonstrated a preservation of the right ventricular function and decreased occurrence of postoperative right heart failure due to a reduction of volume overload .…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, some studies give hint that TVR does not have a beneficial effect . In 2015 Oezpeker et al demonstrated that end‐stage heart failure patients with TR grade >2 undergoing LVAD implants do not benefit from concomitant TVR .…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Implantation of HeartWare Assist Device and Simultaneous Tricuspid Valve Reconstruction Through Partial Upper Sternotomy

et al. 2016

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Left ventricular assist device (LVAD) implantation is a well-established therapy to support patients with end-stage heart failure. However, the operative procedure is associated with severe trauma. Third generation LVADs like the HeartWare assist device (HeartWare, Inc., Framingham, MA, USA) are characterized by enhanced technology despite smaller size. These devices offer new minimally invasive surgical options. Tricuspid regurgitation requiring valve repair is frequent in patients with the need for mechanical circulatory support as it is strongly associated with ischemic and nonischemic cardiomyopathy. We report on HeartWare LVAD implantation and simultaneous tricuspid valve reconstruction through minimally invasive access by partial upper sternotomy to the fifth left intercostal space. Four male patients (mean age 51.72 ± 11.95 years) suffering from chronic heart failure due to dilative (three patients) and ischemic (one patient) cardiomyopathy and also exhibiting concomitant tricuspid valve insufficiency due to annular dilation underwent VAD implantation and tricuspid valve annuloplasty. Extracorporeal circulation was established via the ascending aorta, superior vena cava, and right atrium. In all four cases the LVAD implantation and tricuspid valve repair via partial median sternotomy was successful. During the operative procedure, no conversion to full sternotomy was necessary. One patient needed postoperative re-exploration because of pericardial effusion. No postoperative focal neurologic injury was observed. New generation VADs are advantageous because of the possibility of minimally invasive implantation procedure which can therefore minimize surgical trauma. Concomitant tricuspid valve reconstruction can also be performed simultaneously through partial upper sternotomy. Nevertheless, minimally invasive LVAD implantation is a challenging operative technique.

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“…Owing to donor heart shortage, left-ventricular assist devices (LVAD) are increasingly used as a bridge to heart transplantation in patients with end stage heart failure. In some patients, end-stage left ventricular dysfunction is associated with hemodynamically significant functional tricuspid valve (TV) regurgitation leading to further dilatation of the right heart chambers, progression of right ventricular dysfunction [1]. LVAD implantation usually results in unloading of left ventricle and a consecutive reduction in mitral and tricuspidal regurgitation grade.…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Assist Device With Concominant Tricuspid Valve Repair: Impact on Right Ventricular Reverse Remodelling and Survival

Jakuška¹,

Veisaitė²,

Ereminas³

et al. 2018

Public Health

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Background. In the end stage heart failure (HF) patients with moderate to severe tricuspid regurgitation (TR), the surgical decision for tricuspid valve (TV) repair during left ventricular assist device (LVAD) implantation surgery is not clear. Methods. We included 31 patient with end-stage heart failure and moderate to severe TVR (≥II degree) to our retrospective study analysis. 19 patients received TV annuloplasty during LVAD implantation (TVR+ group), whereas 12 patients didn’t (TVR- group). Demographic, clinical and echocardiographic parameters were assessed in both groups preoperatively and 1 month after surgery. Overall 12 months survival was analysed with Kaplan – Meier method and compared between groups. Results. Inhospital or 30 days mortality rate in TVR+ and TVR- groups was 21.1% and 8.3%, respectively (p=0.624). The overall survival rates up to 12 months did not differ between groups (75% vs 57.89%, p=0.452). TV regurgitation grade was reduced significantly after LVAD implantation with (p=0.001) and without TV repair (p=0.008). Dimensions of RV and right atrium decreased in TVR+ group (p&lt;0.001). The size of RV did not change significantly in TVRgroup postoperatively, however, the diameter of right atrium reduced significantly in this group (p=0.01). Systolic and mean pulmonary artery pressures decreased significantly in both groups of patients. The indices of RV longitudinal function were reduced preoperatively and did not change after LVAD implantation with and without TV repair. Conclusions. Pulmonary artery pressures decreased in all patients after LVAD implantation, while the diameter of RV reduced significantly in patients after concomitant TV repair. Early postoperative mortality and 1 year survival rates did not differ between end stage heart failure patients after LVAD implantation with or without TV annuloplasty.

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Tricuspid valve repair in patients with left-ventricular assist device implants and tricuspid valve regurgitation: propensity score-adjusted analysis of clinical outcome

Abstract: Data indicate that end-stage heart failure patients with TV regurgitation grade >2 undergoing LVAD implants do not benefit from concomitant TVR. Results have to be confirmed by prospective studies.

Cited by 20 publications

References 18 publications

Impact of tricuspid valve insufficiency on the performance of left ventricular assist devices

Impact of tricuspid valve insufficiency on the performance of left ventricular assist devices

Minimally Invasive Implantation of HeartWare Assist Device and Simultaneous Tricuspid Valve Reconstruction Through Partial Upper Sternotomy

Left Ventricular Assist Device With Concominant Tricuspid Valve Repair: Impact on Right Ventricular Reverse Remodelling and Survival

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