Division of Cardiac and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA.
J Thorac Cardiovasc Surg. 2012 Nov;144(5):1217-21. doi: 10.1016/j.jtcvs.2012.07.064. Epub 2012 Aug 29.
Patients referred for implantable continuous-flow left ventricular assist devices (cfLVAD) frequently have preoperative right heart failure and tricuspid regurgitation (TR). The objective of this report is to examine early clinical benefits of concomitant tricuspid surgery for these patients.
Sixty-one of 200 consecutive cfLVAD patients at our institution displayed preimplant right heart dysfunction and significant TR. Thirty-three underwent cfLVAD plus a tricuspid valve procedure (TVP), and 28 had cfLVAD alone. Preimplant characteristics and clinical outcomes were retrospectively studied. As previously described, post-LVAD right ventricular failure was defined as need for right ventricular assist device (RVAD) support or greater than 14 days of intravenous inotropic support.
Preimplant characteristics were similar between the 2 groups. Cardiopulmonary bypass time was increased for the group that received concomitant TVPs. The most common TVP consisted of an undersizing ring annuloplasty. The cfLVAD-alone group had greater TR after implant relative to the cfLVAD+TVP group. The cfLVAD-alone group experienced greater postprocedure right ventricular failure relative to cfLVAD+TVP (46.4% vs 18.2%; P < .05). Furthermore, prolonged hospitalization was increased for the cfLVAD-alone group versus the cfLVAD+TVP. Survival was similar between the 2 groups.
Concomitant TVP appears to reduce postprocedure right ventricular failure for patients with significant TR undergoing cfLVAD implantation.
接受植入式连续流左心室辅助装置（cfLVAD）治疗的患者常伴有术前右心衰竭和三尖瓣反流（TR）。本报告的目的是探讨同期三尖瓣手术对这些患者的早期临床益处。
本机构 200 例连续 cfLVAD 患者中有 61 例术前存在右心功能障碍和严重 TR。其中 33 例行 cfLVAD 加三尖瓣手术（TVP），28 例行 cfLVAD 单纯治疗。回顾性研究了术前特征和临床结局。如前所述，LVAD 后右心衰竭定义为需要右心室辅助装置（RVAD）支持或静脉正性肌力支持超过 14 天。
两组患者的术前特征相似。行同期 TVP 的患者体外循环时间延长。最常见的 TVP 包括环缩术。cfLVAD 单纯治疗组植入后 TR 较 cfLVAD+TVP 组更大。cfLVAD 单纯治疗组术后右心衰竭发生率高于 cfLVAD+TVP 组（46.4%比 18.2%；P<0.05）。此外，cfLVAD 单纯治疗组术后住院时间延长。两组患者生存率相似。
对于接受 cfLVAD 植入治疗且伴有严重 TR 的患者，同期 TVP 似乎可降低术后右心衰竭的发生率。
