Natural History and Prognosis of Patients with Unrepaired Tricuspid Regurgitation Undergoing Implantation of Left Ventricular Assist Device
| Autor: | Rosana Arnavitzki, Israel Mats, Yoav Hammer, Mordehay Vaturi, Dan Aravot, Victor Rubachevski, Ran Kornowski, Yaron D. Barac, Osnat Itzhaki Ben Zadok, Tuvia Ben Gal, Binyamin Ben-Avraham, Aviv A. Shaul |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Ventricular Dysfunction Right medicine.medical_treatment Biomedical Engineering Biophysics Bioengineering Regurgitation (circulation) Biomaterials Internal medicine medicine.artery medicine Humans In patient Retrospective Studies Heart Failure Univariate analysis business.industry Atrial fibrillation General Medicine Prognosis equipment and supplies medicine.disease Tricuspid Valve Insufficiency Natural history Treatment Outcome medicine.anatomical_structure Ventricular assist device Pulmonary artery Cardiology Vascular resistance Heart-Assist Devices business |
| Zdroj: | ASAIO Journal. 68:508-515 |
| ISSN: | 1058-2916 |
| Popis: | We aimed to describe the natural history of left ventricular assist device (LVAD)-supported patients with preimplantation significant tricuspid regurgitation (TR) in a single-center retrospective analysis of LVAD-implanted patients (2008-2019). TR severity was assessed semiqualitatively using color-Doppler flow: insignificant TR (iTR) was defined as none/mild TR and significant TR (sTR) as ≥moderate TR. Included were 121 LVAD-supported patients of which 53% (n = 64) demonstrated sTR preimplantation. Among patients with pre-LVAD implantation sTR and available echocardiographic data, 55% (n = 26) ameliorated their TR severity grade to iTR during the first-year postsurgery and 55% (n = 17) had iTR at 2-year follow-up. On univariate analysis, predictors for TR severity improvement post-LVAD implantation were preimplant lack of atrial fibrillation, reduced inferior vena cavae diameter, and elevated pulmonary vascular resistance. In patients who failed to improve their TR severity grade, we observed a deterioration in right ventricular (RV) function (pulmonary artery pressure index 2.0 [1.7, 2.9], a decline in RV work index 242 [150, 471] mm Hg·L/m2) and higher loop-diuretics dose requirement. At a median of 21 (IQR 8, 40) months follow-up, clinical LVAD-related complications, heart failure-hospitalizations, and overall survival were similar among patients who improved versus failed to improve their TR severity-grade post-LVAD implantation. In conclusion, LVAD implantation is accompanied by a reduction in TR severity in approximately 50% of patients. In patients who failed to improve their TR severity grade, progressive RV dysfunction was observed. Overall, an isolated LVAD implantation in patients with sTR does not adversely affect survival. |
| Databáze: | OpenAIRE |
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