Utility of concomitant tricuspid valve procedures for patients undergoing implantation of a continuous-flow left ventricular device

Abstract

Concomitant TVP appears to reduce postprocedure right ventricular failure for patients with significant TR undergoing cfLVAD implantation.

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

“…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.…”

“…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. It is unclear whether the increased postoperative RHF relates to the severity of preimplant TR or the TVP itself.…”

“…Interestingly, Piacentino et al 13 have provided data that suggest that concurrent TVP actually reduces the risk of RHF relative to patients who have significant preimplant TR but undergo LVAD alone. We also found that baseline diastolic pulmonary artery pressure ≤25 mm Hg was a univariable predictor of RHF as was central venous pressure/pulmonary capillary wedge pressure ratio >0.4 and any reduction in RV function.…”

Valvular Heart Disease in Patients Supported With Left Ventricular Assist Devices

“…Furthermore, there are no studies examining the impact of concomitant TVR on long-term outcomes, such as survival free of transplant, quality of life, and readmission rates. 30 Several single-center studies have examined the short-term impact of this procedure for moderate-to-severe TR 25,[30][31][32] ; however, to our knowledge, there have been no such multicenter studies.…”

“…31,32 The first involved 115 patients with moderate-to-severe TR, 34 of whom underwent concomitant TVR. A related report looked at 200 consecutive patients with continuous-flow LVAD, 61 of whom had moderate-to-severe TR (33 underwent concomitant TVR).…”