Clinical impact and 'natural' course of uncorrected tricuspid regurgitation after implantation of a left ventricular assist device: an analysis of the European Registry for Patients with Mechanical Circulatory Support (EUROMACS)
| Autor: | Ad J.J.C. Bogers, Theo M M H de By, Kadir Caliskan, Paul Mohacsi, Euromacs Investigators, M. Mostafa Mokhles, Ivan Netuka, Felix Schoenrath, Osama Ibrahim Ibrahim Soliman, Johanna J.M. Takkenberg, Lech Paluszkiewicz, Kevin M Veen |
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| Přispěvatelé: | Cardiothoracic Surgery, Cardiology |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment Left ventricular assist device Tricuspid regurgitation 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Tricuspid Valve Insufficiency Internal medicine medicine Humans Registries Eacts/118 Mortality Retrospective Studies Natural course Heart Failure Tricuspid valve AcademicSubjects/MED00920 business.industry Eacts/173 Hazard ratio Transplantation and Mechanical Circulatory Support General Medicine Middle Aged equipment and supplies medicine.disease Pulmonary hypertension Treatment Outcome medicine.anatomical_structure 030228 respiratory system Ventricular assist device Concomitant Circulatory system Cardiology Surgery Heart-Assist Devices Elevated right atrial pressure Cardiology and Cardiovascular Medicine business Eacts/125 |
| Zdroj: | European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 59(1), 207-216. Elsevier |
| ISSN: | 1873-734X 1010-7940 |
| Popis: | OBJECTIVES Data on the impact and course of uncorrected tricuspid regurgitation (TR) during left ventricular assist device (LVAD) implantation are scarce and inconsistent. This study explores the clinical impact and natural course of uncorrected TR in patients after LVAD implantation. METHODS The European Registry for Patients with Mechanical Circulatory Support was used to identify adult patients with LVAD implants without concomitant tricuspid valve surgery. A mediation model was developed to assess the association of TR with 30-day mortality via other risk factors. Generalized mixed models were used to model the course of post-LVAD TR. Joint models were used to perform sensitivity analyses. RESULTS A total of 2496 procedures were included (median age: 56 years; men: 83%). TR was not directly associated with higher 30-day mortality, but mediation analyses suggested an indirect association via preoperative elevated right atrial pressure and creatinine (P = 0.035) and bilirubin (P = 0.027) levels. Post-LVAD TR was also associated with increased late mortality [hazard ratio 1.16 (1.06–1.3); P = 0.001]. On average, uncorrected TR diminished after LVAD implantation. The probability of having moderate-to-severe TR immediately after an implant in patients with none-to-mild TR pre-LVAD was 10%; in patients with moderate-to-severe TR pre-LVAD, it was 35% and continued to decrease in patients with moderate-to-severe TR pre-LVAD, regardless of pre-LVAD right ventricular failure or pulmonary hypertension. CONCLUSIONS Uncorrected TR pre-LVAD and post-LVAD is associated with increased early and late mortality. Nevertheless, on average, TR diminishes progressively without intervention after an LVAD implant. Therefore, these data suggest that patient selection for concomitant tricuspid valve surgery should not be based solely on TR grade. |
| Databáze: | OpenAIRE |
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