Fate of preoperative moderate mitral regurgitation following left ventricular assist device implantation

Abstract

Objective We examined for improvements in preoperative moderate mitral regurgitation following continuous‐flow left ventricular assist device (cfLVAD) implantation. Methods From 2006 to 2020, 190 patients with moderate MR underwent cfVLAD implant without concomitant mitral valve (MV) surgery. Cardiac dimensions and contractility, as well as valve function, were assessed with an echocardiogram (echo) pre‐cfLVAD, and at approximately 1 month post‐cfLVAD. Outcomes were determined by retrospective chart review. Results Median echo follow‐up was 0.94 (0.53, 1.38) months. Residual significant moderate or greater MR was present in 30/190 (15.8%) on follow‐up. Patients with significant residual MR had larger preoperative left ventricular internal diameters in diastole (74.4 ± 8.7 vs. 71.1.0 ± 9.1 mm, p = .034). Significant residual MR was associated with higher preoperative mean pulmonary artery pressures (OR = 1.055, p = .035) and pulmonary capillary wedge pressures (OR = 1.060, p = .034). Significant residual MR on echo was not associated with any survival difference (p = .325). The 1, 5, and 10 year survival were 89.9%, 55.2%, and 34.2%, respectively. Conclusions For patients with moderate MR undergoing LVAD implantation, the likelihood of significant residual MR is low and mitral intervention in this population is not recommended. However, select patients with larger preoperative left heart dimensions and pulmonary vascular pressures may be at risk for persistent residual MR.

The role of innovative modeling and imaging techniques in improving outcomes in patients with LVAD

“…Mock circulatory loops have been successfully used in the context of studying valvular behavior, large vessel behavior, cardiac chamber behavior, and the performance of implanted devices (11,21,(46)(47)(48). These MCLs often utilize 3D printed or molded anatomical models or "phantoms" to obtain more accurate results (49).…”

Prognostic value of mitral regurgitation in patients undergoing left ventricular assist device deployment: A systematic review and meta‐analysis

“…Of these, 340 relevant articles were read in full and assessed according to our inclusion and exclusion criteria. Following critical appraisal, a total of 19 studies [7][8][9][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] incorporating a total of 11 873 patients were included. The studies described outcomes of patients undergoing LVAD implantation with either MR grade 0-I (8819 patients) or II-III (3096 patients).…”

Role of the mitral valve in left ventricular assist device pathophysiology

“…After LVAD implantation in this population, MR remained severe in 10.7% and moderate in 27.0% ( 32 ). By comparison, only 16% of those with pre-LVAD moderate MR had significant residual MR after LVAD implantation ( 41 ). Posterior displacement of the coaptation point was also an important predictor of MR non-resolution ( 1 ).…”

“…While 37.7% of patients with pre-LVAD severe MR had residual SMR, only 16% of those with moderate MR pre-LVAD had residual SMR ( 41 ). Therefore, a great majority (84%) of patients with pre-LVAD moderate MR had improvement to mild or less following device implant ( 41 ).…”

“…While 37.7% of patients with pre-LVAD severe MR had residual SMR, only 16% of those with moderate MR pre-LVAD had residual SMR ( 41 ). Therefore, a great majority (84%) of patients with pre-LVAD moderate MR had improvement to mild or less following device implant ( 41 ). Indeed, indications for surgical intervention for moderate MR in other non-heart failure settings (e.g., coronary bypass grafting) have been more controversial than the general consensus to correct severe MR ( 42 – 44 ).…”