Impact of Tricuspid Valve Regurgitation in Patients Treated With Implantable Left Ventricular Assist Devices
Background The progression of tricuspid valve regurgitation (TR) and the impact of preoperative TR on postoperative outcomes in patients having left ventricular assist device (LVAD) implantation has not been studied. Methods One hundred seventy-six consecutive implantable LVAD procedures were retros...
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| Veröffentlicht in: | The Annals of thoracic surgery 2011-05, Vol.91 (5), p.1342-1347 |
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| creator | Piacentino, Valentino, MD, PhD Williams, Matthew L., MD Depp, Tim, BS Garcia-Huerta, Karla, BS Blue, Laura, ANP Lodge, Andrew J., MD Mackensen, G. Burkhard, MD, PhD Swaminathan, Madhav, MD Rogers, Joseph G., MD Milano, Carmelo A., MD |
| description | Background The progression of tricuspid valve regurgitation (TR) and the impact of preoperative TR on postoperative outcomes in patients having left ventricular assist device (LVAD) implantation has not been studied. Methods One hundred seventy-six consecutive implantable LVAD procedures were retrospectively reviewed. A total of 137 patients comprised the final study group with complete preimplant characteristics, before and after echocardiogram assessment of TR, and outcomes data. Patients were divided into two groups: insignificant TR (iTR) consisting of those with preimplant TR grades of none, trace, and mild; and significant TR (sTR) consisting of those with moderate and severe TR grades. Results Relative to patients with iTR, patients with sTR were younger (53.6 ± 12.8 versus 58.4 ± 10.0 years, p = 0.02) and more commonly had nonischemic cardiomyopathies (69% versus 38%, p < 0.001). The preimplant incidence of iTR and sTR was 51% and 49%. Immediately after the LVAD implant procedure, TR did not significantly change. At late follow-up (156 ± 272 days), 32% had moderate or severe TR. Also, 41% of the original sTR group persisted with moderate or severe TR. Relative to patients with iTR, patients with sTR required longer postimplant intravenous inotropic support (8.5 versus 5.0 days, p = 0.02), more commonly required a temporary right ventricular assist device, and had a longer postimplant length of hospital stay (27.0 versus 20.0 days, p = 0.03). There was also a trend toward decreased survival for sTR versus iTR (log rank = 0.05). Conclusions Tricuspid regurgitation is not reduced immediately after LVAD implantation. Significant TR is associated with longer postimplant inotropic support and length of hospital stay. |
| doi_str_mv | 10.1016/j.athoracsur.2011.01.053 |
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Burkhard, MD, PhD ; Swaminathan, Madhav, MD ; Rogers, Joseph G., MD ; Milano, Carmelo A., MD</creator><creatorcontrib>Piacentino, Valentino, MD, PhD ; Williams, Matthew L., MD ; Depp, Tim, BS ; Garcia-Huerta, Karla, BS ; Blue, Laura, ANP ; Lodge, Andrew J., MD ; Mackensen, G. Burkhard, MD, PhD ; Swaminathan, Madhav, MD ; Rogers, Joseph G., MD ; Milano, Carmelo A., MD</creatorcontrib><description>Background The progression of tricuspid valve regurgitation (TR) and the impact of preoperative TR on postoperative outcomes in patients having left ventricular assist device (LVAD) implantation has not been studied. Methods One hundred seventy-six consecutive implantable LVAD procedures were retrospectively reviewed. A total of 137 patients comprised the final study group with complete preimplant characteristics, before and after echocardiogram assessment of TR, and outcomes data. Patients were divided into two groups: insignificant TR (iTR) consisting of those with preimplant TR grades of none, trace, and mild; and significant TR (sTR) consisting of those with moderate and severe TR grades. Results Relative to patients with iTR, patients with sTR were younger (53.6 ± 12.8 versus 58.4 ± 10.0 years, p = 0.02) and more commonly had nonischemic cardiomyopathies (69% versus 38%, p < 0.001). The preimplant incidence of iTR and sTR was 51% and 49%. Immediately after the LVAD implant procedure, TR did not significantly change. At late follow-up (156 ± 272 days), 32% had moderate or severe TR. Also, 41% of the original sTR group persisted with moderate or severe TR. Relative to patients with iTR, patients with sTR required longer postimplant intravenous inotropic support (8.5 versus 5.0 days, p = 0.02), more commonly required a temporary right ventricular assist device, and had a longer postimplant length of hospital stay (27.0 versus 20.0 days, p = 0.03). There was also a trend toward decreased survival for sTR versus iTR (log rank = 0.05). Conclusions Tricuspid regurgitation is not reduced immediately after LVAD implantation. Significant TR is associated with longer postimplant inotropic support and length of hospital stay.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/j.athoracsur.2011.01.053</identifier><identifier>PMID: 21457940</identifier><identifier>CODEN: ATHSAK</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiothoracic Surgery ; Cohort Studies ; Echocardiography, Doppler ; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care ; Endocardial and cardiac valvular diseases ; Female ; Follow-Up Studies ; Heart ; Heart Failure - complications ; Heart Failure - diagnostic imaging ; Heart Failure - mortality ; Heart Failure - surgery ; Heart-Assist Devices ; Hospital Mortality - trends ; Humans ; Intensive care medicine ; Kaplan-Meier Estimate ; Male ; Medical sciences ; Middle Aged ; Pneumology ; Postoperative Care ; Postoperative Complications - mortality ; Postoperative Complications - physiopathology ; Preoperative Care - methods ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Statistics, Nonparametric ; Surgery ; Survival Analysis ; Treatment Outcome ; Tricuspid Valve Insufficiency - complications ; Tricuspid Valve Insufficiency - diagnostic imaging ; Tricuspid Valve Insufficiency - mortality ; Tricuspid Valve Insufficiency - surgery</subject><ispartof>The Annals of thoracic surgery, 2011-05, Vol.91 (5), p.1342-1347</ispartof><rights>The Society of Thoracic Surgeons</rights><rights>2011 The Society of Thoracic Surgeons</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c458t-fe62454b9ad4f8663d072dcf7bf6a4360fb88bc7be2dfbaf8c053a0fc34fe2fd3</citedby><cites>FETCH-LOGICAL-c458t-fe62454b9ad4f8663d072dcf7bf6a4360fb88bc7be2dfbaf8c053a0fc34fe2fd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24138104$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21457940$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Piacentino, Valentino, MD, PhD</creatorcontrib><creatorcontrib>Williams, Matthew L., MD</creatorcontrib><creatorcontrib>Depp, Tim, BS</creatorcontrib><creatorcontrib>Garcia-Huerta, Karla, BS</creatorcontrib><creatorcontrib>Blue, Laura, ANP</creatorcontrib><creatorcontrib>Lodge, Andrew J., MD</creatorcontrib><creatorcontrib>Mackensen, G. Burkhard, MD, PhD</creatorcontrib><creatorcontrib>Swaminathan, Madhav, MD</creatorcontrib><creatorcontrib>Rogers, Joseph G., MD</creatorcontrib><creatorcontrib>Milano, Carmelo A., MD</creatorcontrib><title>Impact of Tricuspid Valve Regurgitation in Patients Treated With Implantable Left Ventricular Assist Devices</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>Background The progression of tricuspid valve regurgitation (TR) and the impact of preoperative TR on postoperative outcomes in patients having left ventricular assist device (LVAD) implantation has not been studied. Methods One hundred seventy-six consecutive implantable LVAD procedures were retrospectively reviewed. A total of 137 patients comprised the final study group with complete preimplant characteristics, before and after echocardiogram assessment of TR, and outcomes data. Patients were divided into two groups: insignificant TR (iTR) consisting of those with preimplant TR grades of none, trace, and mild; and significant TR (sTR) consisting of those with moderate and severe TR grades. Results Relative to patients with iTR, patients with sTR were younger (53.6 ± 12.8 versus 58.4 ± 10.0 years, p = 0.02) and more commonly had nonischemic cardiomyopathies (69% versus 38%, p < 0.001). The preimplant incidence of iTR and sTR was 51% and 49%. Immediately after the LVAD implant procedure, TR did not significantly change. At late follow-up (156 ± 272 days), 32% had moderate or severe TR. Also, 41% of the original sTR group persisted with moderate or severe TR. Relative to patients with iTR, patients with sTR required longer postimplant intravenous inotropic support (8.5 versus 5.0 days, p = 0.02), more commonly required a temporary right ventricular assist device, and had a longer postimplant length of hospital stay (27.0 versus 20.0 days, p = 0.03). There was also a trend toward decreased survival for sTR versus iTR (log rank = 0.05). Conclusions Tricuspid regurgitation is not reduced immediately after LVAD implantation. Significant TR is associated with longer postimplant inotropic support and length of hospital stay.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiothoracic Surgery</subject><subject>Cohort Studies</subject><subject>Echocardiography, Doppler</subject><subject>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</subject><subject>Endocardial and cardiac valvular diseases</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart Failure - complications</subject><subject>Heart Failure - diagnostic imaging</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - surgery</subject><subject>Heart-Assist Devices</subject><subject>Hospital Mortality - trends</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pneumology</subject><subject>Postoperative Care</subject><subject>Postoperative Complications - mortality</subject><subject>Postoperative Complications - physiopathology</subject><subject>Preoperative Care - methods</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><subject>Statistics, Nonparametric</subject><subject>Surgery</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><subject>Tricuspid Valve Insufficiency - complications</subject><subject>Tricuspid Valve Insufficiency - diagnostic imaging</subject><subject>Tricuspid Valve Insufficiency - mortality</subject><subject>Tricuspid Valve Insufficiency - surgery</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkt9rFDEQx4NY7Fn9FyQv4tOeSTbZHy9CrdoWDipa62PIJpM2597uNZM96H_fLHe24JMwkAz5zHcmX4YQytmSM159XC9NuhujsTjFpWCcL1kOVb4gC66UKCqh2pdkwRgrC9nW6pi8RlznVOTnV-RYcKnqVrIF6S83W2MTHT29jsFOuA2O3ph-B_QH3E7xNiSTwjjQMNDv-QZDwkyCSeDo75DuaBbozZBM1wNdgU_0JjOzVG8iPUUMmOgX2AUL-IYcedMjvD2cJ-TXt6_XZxfF6ur88ux0VVipmlR4qIRUsmuNk76pqtKxWjjr685XRpYV813TdLbuQDjfGd_Y_HXDvC2lB-FdeUI-7HW3cbyfAJPeBLTQ5zlhnFA3leStEopnstmTNo6IEbzexrAx8UFzpmer9Vo_W61nqzXLocpc-u7QZOo24J4K_3qbgfcHwKA1vY9msAGfOcnLhjOZuc97DrIluwBRo80-W3Ahgk3ajeF_pvn0j4jtwxBy3z_wALgepzhkyzXXKDTTP-fVmDeD87wUUlTlIxMluUs</recordid><startdate>20110501</startdate><enddate>20110501</enddate><creator>Piacentino, Valentino, MD, PhD</creator><creator>Williams, Matthew L., MD</creator><creator>Depp, Tim, BS</creator><creator>Garcia-Huerta, Karla, BS</creator><creator>Blue, Laura, ANP</creator><creator>Lodge, Andrew J., MD</creator><creator>Mackensen, G. Burkhard, MD, PhD</creator><creator>Swaminathan, Madhav, MD</creator><creator>Rogers, Joseph G., MD</creator><creator>Milano, Carmelo A., MD</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110501</creationdate><title>Impact of Tricuspid Valve Regurgitation in Patients Treated With Implantable Left Ventricular Assist Devices</title><author>Piacentino, Valentino, MD, PhD ; Williams, Matthew L., MD ; Depp, Tim, BS ; Garcia-Huerta, Karla, BS ; Blue, Laura, ANP ; Lodge, Andrew J., MD ; Mackensen, G. Burkhard, MD, PhD ; Swaminathan, Madhav, MD ; Rogers, Joseph G., MD ; Milano, Carmelo A., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c458t-fe62454b9ad4f8663d072dcf7bf6a4360fb88bc7be2dfbaf8c053a0fc34fe2fd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiothoracic Surgery</topic><topic>Cohort Studies</topic><topic>Echocardiography, Doppler</topic><topic>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</topic><topic>Endocardial and cardiac valvular diseases</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heart Failure - complications</topic><topic>Heart Failure - diagnostic imaging</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - surgery</topic><topic>Heart-Assist Devices</topic><topic>Hospital Mortality - trends</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pneumology</topic><topic>Postoperative Care</topic><topic>Postoperative Complications - mortality</topic><topic>Postoperative Complications - physiopathology</topic><topic>Preoperative Care - methods</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><topic>Statistics, Nonparametric</topic><topic>Surgery</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Tricuspid Valve Insufficiency - complications</topic><topic>Tricuspid Valve Insufficiency - diagnostic imaging</topic><topic>Tricuspid Valve Insufficiency - mortality</topic><topic>Tricuspid Valve Insufficiency - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Piacentino, Valentino, MD, PhD</creatorcontrib><creatorcontrib>Williams, Matthew L., MD</creatorcontrib><creatorcontrib>Depp, Tim, BS</creatorcontrib><creatorcontrib>Garcia-Huerta, Karla, BS</creatorcontrib><creatorcontrib>Blue, Laura, ANP</creatorcontrib><creatorcontrib>Lodge, Andrew J., MD</creatorcontrib><creatorcontrib>Mackensen, G. Burkhard, MD, PhD</creatorcontrib><creatorcontrib>Swaminathan, Madhav, MD</creatorcontrib><creatorcontrib>Rogers, Joseph G., MD</creatorcontrib><creatorcontrib>Milano, Carmelo A., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Piacentino, Valentino, MD, PhD</au><au>Williams, Matthew L., MD</au><au>Depp, Tim, BS</au><au>Garcia-Huerta, Karla, BS</au><au>Blue, Laura, ANP</au><au>Lodge, Andrew J., MD</au><au>Mackensen, G. Burkhard, MD, PhD</au><au>Swaminathan, Madhav, MD</au><au>Rogers, Joseph G., MD</au><au>Milano, Carmelo A., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Tricuspid Valve Regurgitation in Patients Treated With Implantable Left Ventricular Assist Devices</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>2011-05-01</date><risdate>2011</risdate><volume>91</volume><issue>5</issue><spage>1342</spage><epage>1347</epage><pages>1342-1347</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><coden>ATHSAK</coden><abstract>Background The progression of tricuspid valve regurgitation (TR) and the impact of preoperative TR on postoperative outcomes in patients having left ventricular assist device (LVAD) implantation has not been studied. Methods One hundred seventy-six consecutive implantable LVAD procedures were retrospectively reviewed. A total of 137 patients comprised the final study group with complete preimplant characteristics, before and after echocardiogram assessment of TR, and outcomes data. Patients were divided into two groups: insignificant TR (iTR) consisting of those with preimplant TR grades of none, trace, and mild; and significant TR (sTR) consisting of those with moderate and severe TR grades. Results Relative to patients with iTR, patients with sTR were younger (53.6 ± 12.8 versus 58.4 ± 10.0 years, p = 0.02) and more commonly had nonischemic cardiomyopathies (69% versus 38%, p < 0.001). The preimplant incidence of iTR and sTR was 51% and 49%. Immediately after the LVAD implant procedure, TR did not significantly change. At late follow-up (156 ± 272 days), 32% had moderate or severe TR. Also, 41% of the original sTR group persisted with moderate or severe TR. Relative to patients with iTR, patients with sTR required longer postimplant intravenous inotropic support (8.5 versus 5.0 days, p = 0.02), more commonly required a temporary right ventricular assist device, and had a longer postimplant length of hospital stay (27.0 versus 20.0 days, p = 0.03). There was also a trend toward decreased survival for sTR versus iTR (log rank = 0.05). Conclusions Tricuspid regurgitation is not reduced immediately after LVAD implantation. Significant TR is associated with longer postimplant inotropic support and length of hospital stay.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>21457940</pmid><doi>10.1016/j.athoracsur.2011.01.053</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cardiology. Vascular system Cardiothoracic Surgery Cohort Studies Echocardiography, Doppler Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Endocardial and cardiac valvular diseases Female Follow-Up Studies Heart Heart Failure - complications Heart Failure - diagnostic imaging Heart Failure - mortality Heart Failure - surgery Heart-Assist Devices Hospital Mortality - trends Humans Intensive care medicine Kaplan-Meier Estimate Male Medical sciences Middle Aged Pneumology Postoperative Care Postoperative Complications - mortality Postoperative Complications - physiopathology Preoperative Care - methods Retrospective Studies Risk Assessment Severity of Illness Index Statistics, Nonparametric Surgery Survival Analysis Treatment Outcome Tricuspid Valve Insufficiency - complications Tricuspid Valve Insufficiency - diagnostic imaging Tricuspid Valve Insufficiency - mortality Tricuspid Valve Insufficiency - surgery |
| title | Impact of Tricuspid Valve Regurgitation in Patients Treated With Implantable Left Ventricular Assist Devices |
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