Right heart failure and benefits of adjuvant tricuspid valve repair in patients undergoing left ventricular assist device implantation

Tomoyuki Fujita, Junjiro Kobayashi, Hiroki Hata, Osamu Seguchi, Yoshihiro Murata, Masanobu Yanase, Takeshi Nakatani

研究成果: Article査読

19 被引用数 (Scopus)

抄録

OBJECTIVES: Although right heart failure (RVF) is an important issue in the management of patients with left ventricular assist devices (LVADs), the benefits of performing tricuspid valve repair in conjunction with LVAD implantation have not been demonstrated. METHODS: We retrospectively reviewed the records of 141 patients who received LVAD implantation as a bridge to transplant from May 1999 to January 2013. We assessed short- and long-term right heart function in 69 of these patients who underwent tricuspid valve repair because of moderate-to-severe tricuspid regurgitation (TR) or severe dilatation of the tricuspid annulus. RVF was defined as the need for a right ventricular assist device or >30 days of intravenous inotropic support. TR was graded from 0 to 4, while fibrosis in myocardial biopsy samples was graded pathologically from 0 to 3. RESULTS: The average duration of LVAD support was 595 days. Twenty-seven patients developed RVF and their survival rate was significantly worse than that of patients who did not develop RVF (65 vs 91% at 1 year). RVF was significantly related to high preoperative ratio of central venous pressure (CVP) to pulmonary capillary wedge pressure, high total bilirubin, high fibrosis score and high TR grade. In patients who underwent tricuspid valve repair, the TR grade was significantly reduced from 2.6 to 1.0, and this decrease was maintained for 2 years. Although patients who underwent tricuspid valve repair had significantly higher TR grades, ratios of CVP to pulmonary capillary wedge pressure and fibrosis scores preoperatively, no survival impairment was seen. CONCLUSIONS: Tricuspid valve repair is a useful and durable adjuvant procedure for restoring deteriorated right ventricular function in patients requiring LVAD implantation.

本文言語English
ページ(範囲)802-807
ページ数6
ジャーナルEuropean Journal of Cardio-thoracic Surgery
46
5
DOI
出版ステータスPublished - 01-11-2014
外部発表はい

All Science Journal Classification (ASJC) codes

  • 外科
  • 呼吸器内科
  • 循環器および心血管医学

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