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Hemodynamics of concomitant tricuspid valve procedures at LVAD implantation
Author(s) -
Imamura Teruhiko,
Narang Nikhil,
Nnanabu Jerry,
Rodgers Daniel,
Raikhelkar Jayant,
Kalantari Sara,
Smith Bryan,
Nguyen Ann,
Chung Ben,
Ota Takeyoshi,
Song Tae,
Jeevanandam Valluvan,
Kim Gene,
Sayer Gabriel,
Uriel Nir
Publication year - 2019
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.14275
Subject(s) - medicine , concomitant , cardiology , hemodynamics , cardiac index , ventricular assist device , regurgitation (circulation) , tricuspid valve , cardiac output , heart failure
Background Tricuspid regurgitation (TR) is common in patients receiving left ventricular assist device (LVAD) implantation. The current literature is conflicting regarding the effects of concomitant tricuspid valve repair (TVR) at LVAD implantation. We investigated the hemodynamic effects of concomitant TVR at LVAD implantation. Methods Consecutive clinically stable LVAD outpatients who underwent hemodynamic ramp testings were enrolled in this study, and they were stratified by concomitant TVR. Results of hemodynamic ramp tests were compared between the TVR group and the non‐TVR group. Results Among 65 LVAD patients undergoing ramp tests, 34 patients had received TVR, and 31 had not. There were no significant differences in baseline characteristics between two groups except for higher degree of TR and lower pulmonary artery pulsatility index in the TVR group ( P < .05 for both). Following LVAD implantation, the degree of TR improved significantly in the TVR group down to the comparable level with the non‐TVR group. During ramp tests, the TVR group had steeper cardiac index slope (0.14 ± 0.12 vs 0.07 ± 0.07 L/min/m 2 /step, P = .002) and higher cardiac index at set LVAD speed (2.99 ± 0.84 vs 2.52 ± 0.42 L/min/m 2 , P = .007). Conclusions Concomitant TVR improves cardiac output and its response to LVAD speed change following LVAD implantation. Longitudinal clinical implications of such hemodynamic changes are unknown.