Durability and Efficacy of Tricuspid Valve Repair in Patients Undergoing Left Ventricular Assist Device Implantation.

Abstract

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). CONCLUSION: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.

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Citation

Published Version (Please cite this version)

10.1016/j.jchf.2019.08.016

Publication Info

Barac, Yaron D, Alina Nicoara, Muath Bishawi, Jacob N Schroder, Mani A Daneshmand, Nazish K Hashmi, Eric Velazquez, Joseph G Rogers, et al. (2019). Durability and Efficacy of Tricuspid Valve Repair in Patients Undergoing Left Ventricular Assist Device Implantation. JACC. Heart failure. 10.1016/j.jchf.2019.08.016 Retrieved from https://hdl.handle.net/10161/19724.

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Scholars@Duke

Nicoara

Alina Nicoara

Professor of Anesthesiology
Bishawi

Muath Bishawi

House Staff

I am interested in translational and biomedical engineering approaches to studying cardiovascular function and end stage heart failure.  My current work is focused on using Tissue Engineered Blood Vessels (TEBVs) to model radiation related injury to the cardiovascular function.  Additional focus includes ex-vivo modification of donor hearts to improve cardiac transplantation outcomes

My clinical research is focused on clinical outcomes after adult cardiac surgery with a focus on end stage surgical heart failure and transplantation.

Truskey Lab: http://truskeylab.pratt.duke.edu/
Milano-Bowles Lab
Duke Transplant Center
Duke Medx

Schroder

Jacob Niall Schroder

Assistant Professor of Surgery
Hashmi

Nazish Khalid Hashmi

Assistant Professor of Anesthesiology
Patel

Chetan B. Patel

Associate Professor of Medicine
Milano

Carmelo Alessio Milano

Joseph W. and Dorothy W. Beard Distinguished Professor of Experimental Surgery

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