{"doi":"10.1016/j.xjtc.2023.02.014","title":"Concomitant triple-valve repair with durable left ventricular assist device implantation in severe right ventricle dysfunction","abstract":"Central MessageConcomitant valve repair with left ventricular assist device implant can be safe. This is expected to be most beneficial for those with right ventricle dysfunction and for destination indications. Concomitant valve repair with left ventricular assist device implant can be safe. This is expected to be most beneficial for those with right ventricle dysfunction and for destination indications. Aortic insufficiency (AI) reduces the efficacy of left ventricular assist device (LVAD) support.1Cowger J. Pagani F.D. Haft J.W. Romano M.A. Aaronson K.D. Kolias T.J. The development of aortic insufficiency in left ventricular assist device-supported patients.Circ Heart Fail. 2010; 3: 668-674https://doi.org/10.1161/CIRCHEARTFAILURE.109.917765Crossref PubMed Scopus (282) Google Scholar Recently, significant mitral regurgitation (MR) after LVAD implant has been shown to raise pulmonary pressures and worsen right ventricle (RV) function.2Noly P.E. Duggal N. Jiang M. Nordsletten D. Bonini M. Lei I. et al.Role of the mitral valve in left ventricular assist device pathophysiology.Front. Cardiovasc. Med. 2022; 91018295https://doi.org/10.3389/fcvm.2022.1018295Crossref Scopus (3) Google Scholar It is controversial whether tricuspid regurgitation (TR) is simply a marker of RV dysfunction or has an influence on RV output.3Mullan C. Caraballo C. Ravindra N.G. Miller P.E. Mori M. McCullough M. et al.Clinical impact of concomitant tricuspid valve procedures during left ventricular assist device implantation.J Heart Lung Transplant. 2020; 39: 926-933https://doi.org/10.1016/j.healun.2020.05.007Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Therefore, concomitant valvular repair may maximize the benefits of mechanical support. Comprehensive valve optimization (Figure 1) can reduce hospital readmissions, improve symptoms, and benefit survival.1Cowger J. Pagani F.D. Haft J.W. Romano M.A. Aaronson K.D. Kolias T.J. The development of aortic insufficiency in left ventricular assist device-supported patients.Circ Heart Fail. 2010; 3: 668-674https://doi.org/10.1161/CIRCHEARTFAILURE.109.917765Crossref PubMed Scopus (282) Google Scholar,2Noly P.E. Duggal N. Jiang M. Nordsletten D. Bonini M. Lei I. et al.Role of the mitral valve in left ventricular assist device pathophysiology.Front. Cardiovasc. Med. 2022; 91018295https://doi.org/10.3389/fcvm.2022.1018295Crossref Scopus (3) Google Scholar A 65-year-old man with dilated cardiomyopathy presented with end-stage heart failure with recurrent admissions despite maximal guideline directed medical therapy (institutional review board No. HUM00132895; approved May 12, 2022). Written informed consent for publication of study data was obtained from the patient discussed in this report. Echocardiography showed an LV end diastolic diameter of 80 mm, LV ejection fraction of 15%, and an enlarged left atrium of 57 mm. Severe MR was present with annular dilatation and leaflet restriction along with severe TR, and moderate AI. RV function was severely reduced with a tricuspid annular plane systolic excursion of 8.4 mm (Video 1). Poor right heart hemodynamic parameters were shown with a right atrial pressure of 16 mm Hg, pulmonary artery pressure of 56/31 mm Hg, cardiac index of 1.7 L/min/m2, pulmonary vascular resistance of 3.95 Wood Units, and pulmonary artery pulsatility index of 1.56. Multidisciplinary evaluation recommended destination LVAD therapy given poorly controlled diabetes. Triple valve repair strategies in the LVAD setting:•Cardiopulmonary bypass was established with aortic and bicaval cannulation.•Air embolism risk was minimized by venting the right superior pulmonary vein into the LV, ascending aorta, and LV apex.•The HeartMate 3 apical cuff (Abbott) was sutured onto the LV apex, which was then punctured with a blade, dilated, and a floppy pump sucker was passed into the LV cavity for venting.•After returning the heart to its native position, the aorta was clamped and given AI, cardiop","journal":"JTCVS Techniques","year":2023,"id":385964,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9478,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":722069,"name":"Michael J. Pienta","orcid":"0000-0002-8174-0240","position":1,"is_corresponding":false},{"id":626256,"name":"Paul C. Tang","orcid":"0000-0003-4211-8587","position":2,"is_corresponding":false},{"id":1154309,"name":"Hüseyin Sicim","orcid":"0000-0003-3430-3862","position":0,"is_corresponding":true}],"reference_count":5,"raw_metadata":null,"created_at":"2026-07-19T01:17:56.803401Z","pmid":"37324323","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}