Objective: Patients with severe left heart failure accompanied by moderate to severe right ventricular (RV) dysfunction and moderate to severe tricuspid regurgitation (TR) have been often considered for bi-ventricular assist device support (BIVAD). We have postulated that implantation of left ventricular assist device (LVAD) with concomitant tricuspid valve annuloplasty (TVA) might be suffice to improve the right ventricular function of these patients and render BIVAD implantation unnecessary .
Patients and Methods: The medical records of 22 patients who underwent HeartMate II LVAD implantation at the Sheba Medical Center between 2006 and 2012 were retrospectively reviewed. Echocardiographic, hemodynamic, laboratory, intraoperative data and short and long term survival results were compared between 15 patients who underwent LVAD implantation only and 7 patients who underwent LVAD implantation and TVA. Both groups had similar pre-operative clinical characteristics, except for the right ventricular size and function which was significantly worse by all echocardiographic parameters and tricuspid regurgitation which was moderate to severe in all patients who underwent concomitant TVA.
Results: None of the patients who underwent LVAD+TVA had postoperative significant TR while 3 of the 15 LVAD had moderate to severe TR. There was a trend of improved RV function parameters in patients who underwent LVAD+TVA compared to patients who underwent LVAD alone. There was a similar prevalence of short term postoperative complications and short and long term survival was similar in both groups.
Conclusion: Patients suffering of severe left ventricular failure with moderate to severe RV failure and moderate to severe TR may be safely and successfully saved by implantation of LVAD concomitant with TVA which might render BIVAD implantation unnecessary.
