Residual mitral regurgitation in patients with left ventricular assist device support – An INTERMACS analysis

Jain, Rashmi; Truby, Lauren K.; Topkara, V.K.

doi:10.1016/j.healun.2022.03.002

Cited by 11 publications

(18 citation statements)

References 25 publications

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“…In the MOMENTUM 3 trial, persistent MR was uncommon (~6.5% at 1-year, n = 619), and was not associated with survival, adverse events including right HF, or functional capacity [74]. However, in INTERMACS (n = 8364), persistent MR was ~3-fold more common (18.8% at a median of 15 months), and was associated with increased rates of right HF and renal failure, and a modest 16% increase in mortality of borderline significance (p = 0.07) [75]. Single center studies also show mixed results, with frequent right HF but little to no impact on survival.…”

Section: Natural History Of Aortic Insufficiency (Ai) After Lvad Impl...mentioning

confidence: 94%

“…These data suggest there is little benefit to correcting MR at the time of LVAD and risk predictors have not been established to identify subgroups who might derive benefit. However, in INTERMACS, the presence of moderate or severe MR at least 3-months after LVAD implant was associated with a nearly 2-fold increased risk of right HF and a trend towards lower survival [75]. Data are lacking to guide management in LVAD patients with significant residual MR.…”

Section: Mitral Valve Diseasementioning

confidence: 99%

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Recurrent Heart Failure after Left Ventricular Assist Device Placement

Alexy¹,

Burke²

2023

Ventricular Assist Devices - Advances and Applications in Heart Failure

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A host of complications are common after left ventricular assist device (LVAD) surgery. Perhaps none is more challenging to manage than recurrent heart failure (HF). HF in an LVAD patient is associated with substantial morbidity and increased mortality. HF can occur early or late, can present abruptly or insidiously, and can be due to an array of LVAD-specific problems including pump thrombosis and cannula obstruction, or intrinsic cardiac problems such as right ventricular failure or valvular disease. These disparate etiologies require specific testing and distinct therapeutic strategies. This chapter reviews the causes of recurrent HF after LVAD surgery with particular attention to evaluation and management strategies that can identify and treat these distinct etiologies.

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Section: Natural History Of Aortic Insufficiency (Ai) After Lvad Impl...mentioning

confidence: 94%

Section: Mitral Valve Diseasementioning

confidence: 99%

Recurrent Heart Failure after Left Ventricular Assist Device Placement

Alexy¹,

Burke²

2023

Ventricular Assist Devices - Advances and Applications in Heart Failure

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“…Significant mitral regurgitation (MR) is observed in 40% of patients at the time of LVAD implantation (Figure 5), but >80% experience improvement to mild or less with adequate LV unloading (161). Persistent MR after LVAD is associated with higher mortality, HF admissions, RVF, severe TR and increased PVR with elevated CVP and PA pressures, and also with worse kidney function (162)(163)(164)(165)(166). Patients who received a previous transcatheter edge-to-edge repair can safely undergo LVAD implantation without the need to remove the device if the mean transvalvular gradient remains below 6 mmHg.…”

Section: Mitral Regurgitationmentioning

confidence: 99%

“…Mitral valve repair at the time of LVAD implant is not universally recommended given the high percentage of patients who improve without intervention. Review of the INTERMACS registry shows that mitral valve repair is associated with less MR during follow up, fewer HF admissions, and improved functional capacity and quality of life ( 161 , 164 , 168 , 169 ). Risk factors for significant MR after LVAD include severe MR before LVAD, NICM with large LVEDD, RV dysfunction, significant TR, atrial fibrillation, female sex, younger patients, and HM2 support (vs. HM3) ( 164 , 170 ).…”

Section: Surgical Considerations To Minimize Risk Of Right Ventricula...mentioning

confidence: 99%

Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review

Ródenas-Alesina

Brahmbhatt

Rao

et al. 2022

Front. Cardiovasc. Med.

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Left ventricular assist devices (LVADs) are increasingly common across the heart failure population. Right ventricular failure (RVF) is a feared complication that can occur in the early post-operative phase or during the outpatient follow-up. Multiple tools are available to the clinician to carefully estimate the individual risk of developing RVF after LVAD implantation. This review will provide a comprehensive overview of available tools for RVF prognostication, including patient-specific and right ventricle (RV)-specific echocardiographic and hemodynamic parameters, to provide guidance in patient selection during LVAD candidacy. We also offer a multidisciplinary approach to the management of early RVF, including indications and management of right ventricular assist devices in this setting to provide tools that help managing the failing RV.

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“…Data on long term outcomes in patients with residual MR is conflicting. A recent INTERMACS analysis of patients receiving implants between 2006 and 2017 revealed that 18.8% of patients had at least moderate MR at 3 months post LVAD implant ( 65 ). Incidence of late right heart failure and renal failure were higher post-operatively, and there was a trend toward increased longer term mortality.…”

Section: Mitral Valvementioning

confidence: 99%

Pathophysiology and management of valvular disease in patients with destination left ventricular assist devices

Dimarakis

Callan²,

Khorsandi³

et al. 2022

Front. Cardiovasc. Med.

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Over the last two decades, implantable continuous flow left ventricular assist devices (LVAD) have proven to be invaluable tools for the management of selected advanced heart failure patients, improving patient longevity and quality of life. The presence of concomitant valvular pathology, including that involving the tricuspid, mitral, and aortic valve, has important implications relating to the decision to move forward with LVAD implantation. Furthermore, the presence of concomitant valvular pathology often influences the surgical strategy for LVAD implantation. Concomitant valve repair or replacement is not uncommonly required in such circumstances, which increases surgical complexity and has demonstrated prognostic implications both short and longer term following LVAD implantation. Beyond the index operation, it is also well established that certain valvular pathologies may develop or worsen over time following LVAD support. The presence of pre-existing valvular pathology or that which develops following LVAD implant is of particular importance to the destination therapy LVAD patient population. As these patients are not expected to have the opportunity for heart transplantation in the future, optimization of LVAD support including ameliorating valvular disease is critical for the maximization of patient longevity and quality of life. As collective experience has grown over time, the ability of clinicians to effectively address concomitant valvular pathology in LVAD patients has improved in the pre-implant, implant, and post-implant phase, through both medical management and procedural optimization. Nevertheless, there remains uncertainty over many facets of concomitant valvular pathology in advanced heart failure patients, and the understanding of how to best approach these conditions in the LVAD patient population continues to evolve. Herein, we present a comprehensive review of the current state of the field relating to the pathophysiology and management of valvular disease in destination LVAD patients.

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Residual mitral regurgitation in patients with left ventricular assist device support – An INTERMACS analysis

Cited by 11 publications

References 25 publications

Recurrent Heart Failure after Left Ventricular Assist Device Placement

Recurrent Heart Failure after Left Ventricular Assist Device Placement

Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review

Pathophysiology and management of valvular disease in patients with destination left ventricular assist devices

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