Impact of Tricuspid Valve Regurgitation in Patients Treated With Implantable Left Ventricular Assist Devices

Piacentino, Valentino; Williams, Matthew Leighton; Depp, Tim; Garcia-Huerta, Karla; Blue, Laura; Lodge, Andrew J.; Mackensen, G. Burkhard; Swaminathan, Madhav; Rogers, Joseph G.; Milano, Carmelo A.

doi:10.1016/j.athoracsur.2011.01.053

Cited by 98 publications

(79 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, the present results support International Society for Heart and Lung Transplantation guidelines that for moderate or greater TR, the tricuspid valve should be repaired at the time of LVAD implantation. 7,9,11,19 The results also support the studies by Piacentino et al, 10,12,13 which suggest that TVP may help to mitigate RHF for patients with moderate to severe preimplant TR relative to those who do not receive TVP.…”

Section: September 9 2014supporting

confidence: 80%

See 1 more Smart Citation

Clinical Outcomes After Implantation of a Centrifugal Flow Left Ventricular Assist Device and Concurrent Cardiac Valve Procedures

et al. 2014

View full text Add to dashboard Cite

Background— Cardiac valve procedures are commonly performed concurrently during implantation of left ventricular assist devices, but the added procedural risk has not been studied in detail. Methods and Results— Data from patients receiving the HeartWare Ventricular Assist Device in the ADVANCE bridge to transplant (BTT) trial and continued access protocol were reviewed. Of 382 consecutive patients who completed follow-up between August 2008 and June 2013 (mean time on support 389 days, median 271 days), 262 (68.6%) underwent isolated HeartWare Ventricular Assist Device implantation, 75 (19.6%) a concurrent valve procedure, and 45 (11.8%) concurrent nonvalvular procedures. Of the concurrent valve procedures, 56 were tricuspid, 13 aortic, and 6 mitral. Survival was similar between groups (79% for concurrent valve procedures and 85% for HeartWare Ventricular Assist Device only at 1 year; P =0.33). Concurrent valve procedures were also associated with increased unadjusted early right heart failure (RHF). A multivariable analysis for death and RHF (121 total events) identified female sex (odds ratio=2.0 [95% confidence interval, 1.2–3.3; P =0.0053]) and preimplant tricuspid regurgitation severity (odds ratio=2.9 [95% confidence interval, 1.8–4.8, P <0.0001]) as independent predictors while concurrent tricuspid valve procedures (TVP) were not predictors. Furthermore, patients with significant preimplant tricuspid regurgitation who did not receive a TVP experienced an increased rate of late RHF compared with those who received TVP (0.19 versus 0.05 events per patient-year, respectively; P =0.024). Conclusions— Compared with HeartWare Ventricular Assist Device alone, survival was equivalent for the concurrent valve procedure group. Tricuspid regurgitation severity was the most important predictor of increased postoperative RHF, and concurrent TVP was not an independent predictor of RHF overall. Concurrent TVP may reduce the rate of late RHF for patients with significant preimplant tricuspid insufficiency. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00751972.

show abstract

Section: September 9 2014supporting

confidence: 80%

“…10 Preliminary studies suggest that tricuspid valve repair at the time of LVAD implantation may improve early outcomes and reduce RHF. [11][12][13][14] However, John et al 8 demonstrated increased RHF for patients undergoing concurrent tricuspid valve procedures (TVP) versus LVAD alone.…”

Section: S4 Circulationmentioning

confidence: 99%

Clinical Outcomes After Implantation of a Centrifugal Flow Left Ventricular Assist Device and Concurrent Cardiac Valve Procedures

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Holman et al 29 found that TR acutely worsened, and that RV enlargement persisted 30 days postimplant, presumably because of the mechanisms noted above. In contrast, Piacentino et al 26 found that at late follow-up (mean 156±272 days), TR decreased significantly (32% with moderate-severe TR versus 49% preoperatively), suggesting that RV remodeling is an incomplete and slow process.…”

Section: Effect Of Lvad Implantation On Tricuspid Regurgitationmentioning

confidence: 89%

“…Dilation of the RV leads to secondary tricuspid annular dilation, apical leaflet displacement, and restriction with resultant incomplete coaptation. 25,26 Between 30% and 64% of patients with advanced HF will have associated TR, 26 which further contributes to RV failure through the development of right-sided volume overload and reduced RV ejection. Because development of worsening RV failure after LVAD implantation is associated with reduced survival, 26,27 tricuspid valve (TV) pathology is a major concern at the time of surgery.…”

Section: Tricuspid Valve Pathologymentioning

confidence: 99%

Valvular Heart Disease in Patients Supported With Left Ventricular Assist Devices

Wang

Hernandez

Felker

et al. 2014

Circ: Heart Failure

Self Cite

View full text Add to dashboard Cite

“…A large majority of patients with advanced heart failure will have associated TR which can worsen RV failure, and as such, this pathology is a major concern during consideration for implantation of long-term MCS [25,17]. In the immediate postoperative period, patients with uncorrected TR after LVAD implantation can develop worsening RV failure contributing to early morbidity and mortality.…”

Section: Tricuspid Valve Regurgitationmentioning

confidence: 99%

Current Practice in Patient Selecting for Long-Term Mechanical Circulatory Support

Halbreiner

Soltesz

Starling

et al. 2014

Curr Heart Fail Rep

View full text Add to dashboard Cite

With the advances of mechanical circulatory support, the selection of patients has undergone many changes over the last decade. Determining who is suitable for left ventricular assist device (LVAD) implantation is important to understanding the overall risk and outcomes. As devices improve, it is expected that changes will continue in this field. This review describes current state of patient selection, evaluation, and optimization prior to implantation of a long-term circulatory support device.

show abstract

Impact of Tricuspid Valve Regurgitation in Patients Treated With Implantable Left Ventricular Assist Devices

Cited by 98 publications

References 11 publications

Clinical Outcomes After Implantation of a Centrifugal Flow Left Ventricular Assist Device and Concurrent Cardiac Valve Procedures

Clinical Outcomes After Implantation of a Centrifugal Flow Left Ventricular Assist Device and Concurrent Cardiac Valve Procedures

Valvular Heart Disease in Patients Supported With Left Ventricular Assist Devices

Current Practice in Patient Selecting for Long-Term Mechanical Circulatory Support

Contact Info

Product

Resources

About