Reversibility of severe mitral valve regurgitation after left ventricular assist device implantation: single-centre observations from a real-life population of patients†

Dobrovie, Monica; Spampinato, Ricardo; Efimova, Elena V.; Silva, Jaqueline G. da Rocha e; Fischer, Julia; Kuehl, Michael; Voigt, Jens‐Uwe; Belmans, Ann; Ciarka, Agnieszka; Thome, Fernanda Bonamigo; Schloma, V.; Dmitrieva, Yaroslava; Lehmann, Sven; Hahn, Jochen; Strotdrees, Elfriede; Mohr, Friedrich–Wilhelm; Garbade, Jens; Meyer, Anna

doi:10.1093/ejcts/ezx476

Cited by 18 publications

(24 citation statements)

References 30 publications

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“…The clinical implications of persistent moderate‐to‐severe MR have been mostly reported in single‐centre studies. However, the prognostic significance of persistent moderate‐to‐severe MR in terms of survival and HF hospitalizations is not consistent across studies 6,8 . In the randomized MOMENTUM 3 trial, patients with HeartMate 3 were less likely to have residual MR at 1 month compared with those with HeartMate II but that residual MR did not impact 2 year mortality 19 .…”

Section: Discussionmentioning

confidence: 99%

“…Majority of patients have improvement in FMR after LV unloading and positive effects of LV remodelling with long‐term cfLVAD support. Retrospective, single‐centre studies have shown that the incidence of persistent MR after cfLVAD implantation varies from 2.4% to 20% at 6 month follow‐up 6–8 . Recent reports have emerged challenging the conventional belief of ignoring MR at time of cfLVAD implantation.…”

Section: Introductionmentioning

confidence: 99%

“…Retrospective, single-centre studies have shown that the incidence of persistent MR after cfLVAD implantation varies from 2.4% to 20% at 6 month follow-up. [6][7][8] Recent reports have emerged challenging the conventional belief of ignoring MR at time of cfLVAD implantation. Persistent MR after cfLVAD implantation has been associated with persistent pulmonary hypertension, worsening RV function, shorter time to death, and first hospitalization.…”

Section: Introductionmentioning

confidence: 99%

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Persistent mitral regurgitation after left ventricular assist device: a clinical conundrum

et al. 2021

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Aims Persistent mitral valve regurgitation (MR) after continuous flow left ventricular assist device implantation (cfLVAD) is associated with pulmonary hypertension and right ventricular failure with variable effects on survival across published studies. The aim of this study is to determine the incidence and predictors of persistent MR at 6-month follow-up after cfLVAD implantation and its impact on survival, haemodynamics, right ventricular function, and morbidity. Methods and results We performed a retrospective review of all adult cfLVAD recipients from January 2012 to June 2017 at a single tertiary university hospital with follow-up until April 2019. Primary outcome was to compare survival between patients with no-to-mild compared with persistent moderate-to-severe MR at 6 months. Secondary outcomes included right heart failure (RHF), length of stay, re-hospitalizations, and composite of death, transplant, and pump exchange during the length of follow-up. Final analytic sample was 111 patients. The incidence of persistent moderate or severe MR at 6 months was 26%. Significant predictors of persistent MR at 6 months were left atrium dimension and volume. The group with persistent moderate-to-severe MR at 6 months had higher incidence of RHF at 6 months (45% vs. 25%, P = 0.04). There was no difference in survival at 1 year between the groups (no-to-mild MR 85.5%, moderate-to-severe MR 87.9%, Wilcoxon P-value = 0.63). There was no difference in re-hospitalizations, length of stay, composite of death, transplant, or pump exchange during the length of follow-up between the comparison groups. Conclusions Persistent moderate-to-severe MR after cfLVAD implantation is present in one fourth of patients and is associated with increased incidence of RHF, higher mean pulmonary pressure, and pulmonary capillary wedge pressure with no effect on 1 year survival. Increased left atrium size was associated with persistent moderate-to-severe MR at 6 months.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Persistent mitral regurgitation after left ventricular assist device: a clinical conundrum

et al. 2021

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“…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. 5,6 Whether axial or centrifugal continuous-flow LVADs affect MR similarly or differentially is unknown.…”

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confidence: 99%

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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“…It is clear now that mitral regurgitation does not resolve in all patients. [3][4][5] Although most patients with preoperative severe mitral regurgitation seem to fare quite well (or even better than those without preexisting severe mitral regurgitation! 6 ) postoperatively, there is some evidence that those with persistent moderate to severe mitral regurgitation after LVAD implantation have a poorer prognosis.…”

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confidence: 99%

Commentary: When suction alone is not enough

Bechtel

2020

The Journal of Thoracic and Cardiovascular Surgery

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When I learned in whom and how to implant a left ventricular assist device (LVAD), I was taught, among other things, one statement that I still vividly remember. I was told that there is no need to treat mitral insufficiency because ''the LVAD will suck the left ventricle empty anyway.'' More than a decade later, this statement is still covered by guidelines 1 and current practice. 2 Recent years, however, have somewhat challenged this

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Reversibility of severe mitral valve regurgitation after left ventricular assist device implantation: single-centre observations from a real-life population of patients†

Abstract: Preoperative severe MR resolves in the majority of patients early on after LVAD implantation and is not associated with worse clinical outcomes or intermediate-term survival.

Cited by 18 publications

References 30 publications

Persistent mitral regurgitation after left ventricular assist device: a clinical conundrum

Persistent mitral regurgitation after left ventricular assist device: a clinical conundrum

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

Commentary: When suction alone is not enough

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