Impact of tricuspid valve insufficiency on the performance of left ventricular assist devicesCentral MessagePerspective
Claudio J.R. Gomez Hamacher,
Carolin Torregroza, MD,
Najla Sadat, MD,
Daniel Scheiber, MD,
Jil-Cathrin von der Beek, DVM,
Ralf Westenfeld, MD, PhD,
Ivonne Jeanette Knorr, DVM,
Martin Sager, MD, PhD,
Artur Lichtenberg, MD, PhD,
Diyar Saeed, MD, PhD
Affiliations
Claudio J.R. Gomez Hamacher
Department of Cardiovascular Surgery, University Hospital, Heinrich-Heine University, Dusseldorf, Germany
Carolin Torregroza, MD
Department of Anesthesiology, University Hospital, Heinrich-Heine University, Dusseldorf, Germany
Najla Sadat, MD
Department of Cardiovascular Surgery, University Hospital, Heinrich-Heine University, Dusseldorf, Germany
Daniel Scheiber, MD
Division of Cardiology, Pneumology and Angiology, University Hospital, Heinrich-Heine University, Dusseldorf, Germany
Jil-Cathrin von der Beek, DVM
Central Unit for Animal Research and Animal Welfare Affairs, Heinrich-Heine University, Dusseldorf, Germany
Ralf Westenfeld, MD, PhD
Division of Cardiology, Pneumology and Angiology, University Hospital, Heinrich-Heine University, Dusseldorf, Germany
Ivonne Jeanette Knorr, DVM
Central Unit for Animal Research and Animal Welfare Affairs, Heinrich-Heine University, Dusseldorf, Germany
Martin Sager, MD, PhD
Central Unit for Animal Research and Animal Welfare Affairs, Heinrich-Heine University, Dusseldorf, Germany
Artur Lichtenberg, MD, PhD
Department of Cardiovascular Surgery, University Hospital, Heinrich-Heine University, Dusseldorf, Germany
Diyar Saeed, MD, PhD
Department of Cardiovascular Surgery, University Hospital, Heinrich-Heine University, Dusseldorf, Germany; University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Address for reprints: Diyar Saeed, MD, PhD, University Department of Cardiac Surgery, Leipzig Heart Center, Strümpelstraße 39, 04289 Leipzig, Germany.
Objective: To evaluate the impact of severe tricuspid valve insufficiency (TVI) at the time of left ventricular assist device (LVAD) implantation on the hemodynamic and LVAD parameters in an acute ovine model. Methods: Stable heart failure (HF) was induced in 10 ovines through the application of 3 ± 1 coronary ligations. Once stable HF was obtained (after 15 ± 5 days), the animals were supported with an LVAD. Hemodynamic data and pump parameters were obtained and compared in 2 settings; first with LVAD in place after weaning from the cardiopulmonary bypass machine (no TVI condition) and second following the induction of severe TVI through resection of the tricuspid valve (TVI condition). Results: There were no statistically significant differences in the hemodynamic and pump parameters between TVI condition and no TVI conditions except for lower cardiac output in the TVI condition (2 [1.38-2.8] L/min vs 3.2 [1.55-3.7] L/min, P = .027) and the expected greater central venous pressure in the TVI condition (26 [24-31] mm Hg vs 15 [13-25] mm Hg, P = .020). A median pump flow of 2.8 (2.45-3.75) L/min versus 2.9 (2.75-3.8) L/min in the TVI condition and no TVI condition was documented (P = .160). Conclusions: Results from this acute animal study suggest that severe TVI in HF with preserved right ventricular function does not have significant impact on the LVAD pump parameters. The observed reduction in cardiac output may warrant further investigations, especially under loading conditions.
