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Concomitant tricuspid valve surgery during implantation of continuous-flow left ventricular assist devices: a Society of Thoracic Surgeons database analysis
- Source :
- The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 33(6)
- Publication Year :
- 2013
-
Abstract
- Performing concomitant tricuspid valve procedures (TVPs) in left ventricular assist device (LVAD) patients with significant pre-operative tricuspid regurgitation (TR) is controversial, and no studies have been large enough to definitively guide therapy.Between January 2006 and September 2012, 2,196 patients with moderate to severe pre-operative TR from 115 institutions underwent implantation of a continuous-flow left ventricular assist device (LVAD) as reported by The Society of Thoracic Surgeons National Database. Of these, 588 (27%) underwent a concomitant TVP. Inverse probability weighting based on propensity score was used to adjust for differences between the LVAD alone and LVAD+TVP groups, and outcomes were compared.Most patients in the LVAD+TVP group underwent an annuloplasty alone (81.1%). Concomitant TVP did not affect risk of post-operative right VAD insertion (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.49-1.36; p = 0.4310) or death (RR, 0.95; 95% CI, 0.68-1.33; p = 0.7658). However, TVP was associated with an increased risk for post-operative renal failure (RR, 1.53; 95% CI, 1.13-2.08; p = 0.0061), dialysis (RR, 1.49; 95% CI, 1.03-2.15; p = 0.0339), reoperation (RR, 1.24; 95% CI, 1.07-1.45; p = 0.0056), greater total transfusion requirement (RR, 1.03; 95% CI, 1.01-1.05; p = 0.0013), and hospital length of stay21 days (RR, 1.29; 95% CI, 1.16-1.43; p0.0001). Time on the ventilator and intensive care unit length of stay were also significantly prolonged for the LVAD+TVP group.Performing a concomitant TVP for continuous-flow LVAD patients with moderate to severe TR did not reduce early death or right VAD requirement and was associated with worse early post-operative outcomes. These data caution against routine concomitant TVP based solely on degree of pre-operative TR and suggest that additional selection criteria are needed to identify those patients in whom concomitant TVP may prevent post-operative right ventricular failure.
- Subjects :
- Pulmonary and Respiratory Medicine
Adult
Male
medicine.medical_specialty
Databases, Factual
medicine.medical_treatment
Cardiac Valve Annuloplasty
Internal medicine
medicine
Humans
Propensity Score
Dialysis
Aged
Retrospective Studies
Heart Failure
Transplantation
Tricuspid valve
Continuous flow
business.industry
Middle Aged
Confidence interval
Tricuspid Valve Insufficiency
Surgery
medicine.anatomical_structure
Treatment Outcome
Concomitant
Relative risk
Ventricular assist device
Propensity score matching
Cardiology
Female
Heart-Assist Devices
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 15573117
- Volume :
- 33
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
- Accession number :
- edsair.doi.dedup.....a7826f6b79f0464f85fbd6de4a8feaaf