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Tricuspid Valve Annular Dilation as a Predictor of Right Ventricular Failure After Implantation of a Left Ventricular Assist Device
Author(s) -
Goldraich Livia,
Kawajiri Hiroyuki,
Foroutan Farid,
Braga Juarez,
Billia Phyllis,
Misurka Jimmy,
Stansfield William E.,
Yau Terrence,
Ross Heather J.,
Rao Vivek
Publication year - 2016
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.12685
Subject(s) - medicine , cardiology , right ventricular failure , dilation (metric space) , tricuspid valve , ventricular assist device , heart failure , mathematics , combinatorics
A BSTRACT Background Tricuspid annular (TA) dilation has been suggested as a more reliable marker of concomitant advanced right ventricular failure (RVF) than severity of tricuspid regurgitation (TR). Our objective was to examine the impact of TA dilation on occurrence of RVF and in‐hospital mortality following left ventricular assist device (LVAD) implant. Methods Consecutive patients undergoing implantation of a continuous‐flow LVAD implant were grouped according to the presence or absence of preoperative dilated TA. Clinical characteristics, hemodynamics, and short‐term postoperative outcomes were compared between groups. RVF was defined as unplanned right ventricular assist device (RVAD) or postoperative use of inotropes for >14 days. Linear and logistic regressions were used to explore associations of TA with occurrence of RVF and duration of inotrope use. Results We included 69 patients who had continuous‐flow LVAD implanted between 2006 and 2013 (50 ± 13 years old; 69% males; 37% ischemic etiology; 69% bridge‐to‐transplant LVAD; 18% INTERMACS 1–2; 48% with significant TR). RVF occurred in nine cases, and overall in‐hospital mortality rate was 14%. Tricuspid valve repair was performed in ten cases. Dilated TA (OR 4.86; 95%CI 1.05–22.33; p = 0.04) was associated with RVF. In an adjusted multivariable analysis, indexed TA was an independent predictor of increased days of inotrope use (0.8‐day increase in inotrope use for every 1 mm/m 2 increase; p = 0.04). Conclusion In this cohort, TA dilation was a predictor of RVF after LVAD implant. The potential benefit of concomitant TVR in selected patients with a dilated TA undergoing LVAD implantation remains to be determined. doi: 10.1111/jocs.12685 (J Card Surg 2016;31:110–116)