Concomitant mitral valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: An INTERMACS database analysis

Robertson, Jason O.; Naftel, David C.; Myers, Susan; Tedford, Ryan J.; Joseph, Susan; Kirklin, James K.; Silvestry, Scott C.

doi:10.1016/j.healun.2017.09.016

Cited by 65 publications

(66 citation statements)

References 19 publications

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“…There have been several prior small studies, although mostly uncontrolled, some suggesting a role for mitral surgery and others suggesting it is unnecessary. A recently published large multicenter analysis based on Interagency Registry for Mechanically Assisted Circulatory Support data included more than 250 mitral valve procedures and found lesser hospitalizations and improved functional status in patients who have MVr, 16 thus supporting our findings. However, all these studies have been retrospectively analyzed.…”

Section: Future Directionssupporting

confidence: 87%

Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation

Pawale

Itagaki

Parikh

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Background: The management of severe mitral regurgitation (MR) at the time of left ventricular assist device (LVAD) implantation is controversial. We adopted an approach of systematic repair of severe MR at the time of LVAD implantation and report our experience.Methods: We performed mitral valve repair (MVr) on 78 consecutive patients with severe MR undergoing LVAD implantation at our institution between 2013 and 2017. We compared data on these patients to 28 historical controls with severe MR from the immediate preceding period between 2011 and 2013 where the MR was not treated, using Cox modeling and propensity score methods. Median follow-up time was 17.7 months.From the

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Section: Future Directionssupporting

confidence: 87%

Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation

Pawale

Itagaki

Parikh

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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“…3−6 In registry analyses, concomitant mitral valve (MV) procedures have been associated with reduced hospitalizations and better quality of life but not improved survival. 3 Other multicenter studies have pointed to a survival benefit in those with uncorrected severe MR at baseline. 4 However, single-center studies have demonstrated that post-LVAD implantation residual MR may adversely impact hemodynamics and right ventricular function, whereas others have suggested resolution of severe MR in most cases after LVAD implantation.…”

mentioning

confidence: 98%

Impact of left ventricular assist device implantation on mitral regurgitation: An analysis from the MOMENTUM 3 trial

Kanwar

Rajagopal

Itoh

et al. 2020

The Journal of Heart and Lung Transplantation

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BACKGROUND: Mitral regurgitation (MR) determines pathophysiology and outcome in advanced heart failure. The impact of left ventricular assist device (LVAD) placement on clinically significant MR and its contribution to long-term outcomes has been sparsely evaluated. METHODS: We evaluated the effect of clinically significant MR on patients implanted in the MOMENTUM 3 trial with either the HeartMate II (HMII) or the HeartMate 3 (HM3) at 2 years. Clinical significance was defined as moderate or severe grade MR determined by site-based echocardiograms. RESULTS: Of 927 patients with LVAD implants without a prior or concomitant mitral valve procedure, 403 (43.5%) had clinically significant MR at baseline. At 1-month of support, residual MR was present in 6.2% of patients with HM3 and 14.3% of patients with HMII (relative risk = 0.43; 95% CI, 0.22 −0.84; p = 0.01) with a low rate of worsening at 2 years. Residual MR at 1-month post-implant did not impact 2-year mortality for either the HM3 (hazard ratio [HR],1.41; 95% CI, 0.52−3.89; p = 0.50) or HMII (HR, 0.91; 95% CI, 0.37−2.26; p = 0.84) LVAD. The presence or absence of baseline MR did not influence mortality (HM3 HR, 0.86; 95% CI, 0.56−1.33; p = 0.50; HMII HR, 0.81; 95% CI, 0.54 −1.22; p = 0.32), major adverse events or functional capacity. In multivariate analysis, severe baseline MR (p = 0.001), larger left ventricular dimension (p = 0.002), and implantation with the HMII instead of the HM3 LVAD (p = 0.05) were independently associated with an increased likelihood of persistent MR post-implant.

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“…11 Recently, the INTERMACS registry failed to demonstrate a survival benefit in LVAD patients receiving concomitant MVS. 12 Does concomitant MVS really have no clinical benefit? In this study, we focused on hemodynamic profile and reconsidered the implication of concomitant MVS at LVAD implantation.…”

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confidence: 99%

Hemodynamic Effects of Concomitant Mitral Valve Surgery and Left Ventricular Assist Device Implantation

et al. 2020

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There are conflicting data regarding whether concomitant mitral valve surgery (MVS) at left ventricular assist device (LVAD) implantation is beneficial. This study aimed to assess the hemodynamic effects of concomitant MVS. Of all 73 enrolled patients, 44 patients had undergone concomitant MVS and 29 patients had not. Before LVAD implantation, MVS group had higher pulmonary capillary wedge pressure (p = 0.04). After LVAD implantation, MVS group had higher mean pulmonary artery pressure and cardiac output (CO). During the hemodynamic ramp study, MVS group had steeper CO slopes (0.18 [0.13 0.28] vs. 0.15 [0.08, 0.20] L/min/step; p = 0.04) at incremental LVAD speed and achieved a higher CO at the optimized set speed (5.5 [4.7, 6.9] vs. 4.9 [4.0, 5.7] L/min; p = 0.03). One-year freedom from death or heart failure readmission was statistically comparable between the two groups (61% vs. 80%, p = 0.20). Thus far, after LVAD implantation and concomitant MVS, patients had increased pulmonary hypertension, despite having higher CO and a better response of CO at incremental LVAD speed. The implication of hemodynamic features after concomitant MVS on clinical outcomes warrants further investigation.

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Concomitant mitral valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: An INTERMACS database analysis

Abstract: Concomitant MVPs are not associated with increased survival overall. However, MVPs are associated with benefits in terms of reduced hospital re-admission and improved quality of life in select patients.

Cited by 65 publications

References 19 publications

Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation

Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation

Impact of left ventricular assist device implantation on mitral regurgitation: An analysis from the MOMENTUM 3 trial

Hemodynamic Effects of Concomitant Mitral Valve Surgery and Left Ventricular Assist Device Implantation

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