Clinical impact of concomitant tricuspid valve procedures during left ventricular assist device implantation
Document Type
Article
Publication Title
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
Abstract
BACKGROUND: Tricuspid regurgitation (TR) is common in patients with end-stage heart failure receiving left ventricular assist devices (LVADs), but the benefit of concomitant tricuspid valve procedures (TVPs) remains uncertain. This study examined the impact of TVP at the time of LVAD implantation on clinical outcomes and quality of life (QOL) metrics. METHODS: We included adult patients in the Interagency Registry for Mechanical Circulatory Support database with various degrees of TR who received continuous-flow LVADs from 2008 to 2017. Patients undergoing concomitant TVP were compared with those without the intervention in a stratified analysis. Descriptive analyses, survival analyses, and Andersen‒Gill hazard models were used as appropriate to examine associations with clinical and patient-centered QOL outcomes. RESULTS: Our analysis included 8,263 (53.1%) mild, 4,252 (33.3%) moderate, and 2,100 (13.5%) severe TR cases. TVP rate increased with severity: 8.6% of mild, 18.0% of moderate, and 43.9% of severe cases. TVP was not associated with survival benefit in cases of mild (adjusted hazard ratio [aHR]: 0.97, 95% CI: 0.79-1.19, p = 0.75), moderate (aHR: 1.03, 95% CI: 0.88-1.20, p = 0.72), or severe (aHR: 1.20, 95% CI: 0.98-1.48, p = 0.08) TR. For patients with combined moderate or severe TR, TVP was associated with increased mortality (log-rank p < 0.01, aHR: 1.13, 95% CI: 1.00-1.27, p = 0.04). After adjusting for TR severity, TVP was associated with increased risk of bleeding, arrhythmia, and stroke (p < 0.01 each) and no improvements in QOL (p > 0.05). CONCLUSIONS: TVP at the time of LVAD implantation was not associated with either improved survival or QOL, and there were associations with increased risk of adverse events among patients with moderate and severe TR.
First Page
926
Last Page
933
DOI
10.1016/j.healun.2020.05.007
Publication Date
9-1-2020
Recommended Citation
Mullan, Clancy; Caraballo, Cesar; Ravindra, Neal G.; Miller, P Elliott; Mori, Makoto; McCullough, Megan; Clarke, John-Ross D.; Anwer, Muhammad; Velazquez, Eric J.; Geirsson, Arnar; Desai, Nihar R.; and Ahmad, Tariq, "Clinical impact of concomitant tricuspid valve procedures during left ventricular assist device implantation" (2020). All Research. 145.
https://scholar.bridgeporthospital.org/all_research/145
Identifier
32593561 (pubmed); 10.1016/j.healun.2020.05.007 (doi); S1053-2498(20)31559-X (pii)