Liberal use of tricuspid-valve annuloplasty during left-ventricular assist device implantation.

OBJECTIVE: The study aimed to determine whether liberal use of tricuspid-valve repair (TVr) is associated with adverse outcomes.

METHODS: The study was a retrospective review of 51 implantable left-ventricular assist devices (LVADs) performed in a single center between January 2008 and December 2009. TVr using Edwards MC 3 annuloplasty ring was performed if there was either documented moderate or greater tricuspid regurgitation or severe annular dilatation.

RESULTS: TVr was performed in 37 patients. One patient was converted to replacement intra-operatively. Compared with patients who did not have TVr, the age was similar (mean 52 vs 50 years, p=0.62), as was frequency of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 1 or 2 (43% vs 50%, p=0.13). Day 1 hemodynamics were also similar: mean central venous pressure (13.5 vs 14 mmHg; p=0.10) and mean pulmonary artery pressure (25 vs 25.6 mmHg; p=0.76), as was Day 1 bilirubin (3.1 vs 3.9 mg dl(-1), p=0.27). Median duration of mechanical ventilation (2 days) and inotropic support (5 days) and rates of bleeding were identical in both groups. Although there was a trend toward longer intensive care unit (ICU) stays in the TVr group (6 vs 5 days; p=0.12), as a group these patients experienced less use of blood-product transfusion and less hospital length of stay. Hospital mortality was similar in both groups (TVr 18.9%, no TVr 21.4%, p=0.7).

CONCLUSIONS: TVr can be applied during LVAD implantation without 'obvious' increase in perioperative risk. As there are theoretical benefits to eliminating tricuspid regurgitation, our data argue for a more liberal approach to TVr at the time of LVAD implantation.