Transcatheter Mitral Valve Repair for Severe, Symptomatic Mitral
                        Regurgitation in Patients with Left Ventricular Assist Devices

Raghunathan, Deepa; Arora, Anuja; Aman, Wahaj; Nathan, Sriram; Jumean, Marwan; Gregorič, Igor D.; Kar, Biswajit

doi:10.14797/dpyf8504

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…Some authors questioned whether the presence of >2 MitraClips -an uncommon event- could negatively affect LVAD therapy by: (i) affecting right ventricular function due to the presence of an inter-atrial shunt through the residual atrial septal defect and (ii) decreasing left ventricular filling and LVAD flow as a result of a reduced valve area combined with the increased flow rates after LVAD initiation ( 112 , 113 ). Raghunathan et al reported a case of bidirectional -predominantly right-to-left- shunting immediately after the delivery of two MitraClip XTR in an LVAD patient with right ventricular dysfunction ( 91 ). Percutaneous closure of the transseptal puncture with an Amplatzer occluder device led to symptomatic improvement of the patient's heart failure symptoms ( 91 ).…”

Section: Thv Interventionsmentioning

confidence: 99%

“…Raghunathan et al reported a case of bidirectional -predominantly right-to-left- shunting immediately after the delivery of two MitraClip XTR in an LVAD patient with right ventricular dysfunction ( 91 ). Percutaneous closure of the transseptal puncture with an Amplatzer occluder device led to symptomatic improvement of the patient's heart failure symptoms ( 91 ). Of note, less than 30% of patients have a residual iatrogenic atrial septal defect 1 year from MitraClip treatment ( 114 ).…”

Section: Thv Interventionsmentioning

confidence: 99%

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Transcatheter valvular therapies in patients with left ventricular assist devices

Dagher

Santaló-Corcoy

Perrin

et al. 2023

Front. Cardiovasc. Med.

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Aortic, mitral and tricuspid valve regurgitation are commonly encountered in patients with continuous-flow left ventricular assist devices (CF-LVADs). These valvular heart conditions either develop prior to CF-LVAD implantation or are induced by the pump itself. They can all have significant detrimental effects on patients' survival and quality of life. With the improved durability of CF-LVADs and the overall rise in their volume of implants, an increasing number of patients will likely require a valvular heart intervention at some point during CF-LVAD therapy. However, these patients are often considered poor reoperative candidates. In this context, percutaneous approaches have emerged as an attractive “off-label” option for this patient population. Recent data show promising results, with high device success rates and rapid symptomatic improvements. However, the occurrence of distinct complications such as device migration, valve thrombosis or hemolysis remain of concern. In this review, we will present the pathophysiology of valvular heart disease in the setting of CF-LVAD support to help us understand the underlying rationale of these potential complications. We will then outline the current recommendations for the management of valvular heart disease in patients with CF-LVAD and discuss their limitations. Lastly, we will summarize the evidence related to transcatheter heart valve interventions in this patient population.

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Section: Thv Interventionsmentioning

confidence: 99%

Section: Thv Interventionsmentioning

confidence: 99%

Transcatheter valvular therapies in patients with left ventricular assist devices

Dagher

Santaló-Corcoy

Perrin

et al. 2023

Front. Cardiovasc. Med.

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Impact of preoperative mitral regurgitation on left ventricular assist device patients: propensity score-matched analysis of the EUROMACS dataset

Loforte¹,

Nersesian

Lewin

et al. 2023

European Journal of Cardio-Thoracic Surgery

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Introduction Mitral regurgitation (MR) is frequently observed in patients undergoing left ventricular assist device (LVAD) implantation. We investigated the impact of preoperative MR on LVAD patients. Methods A retrospective propensity score-matched analysis of adult patients enrolled in the EUROMACS registry between 01/01/2011 and 30/11/2021 was performed. Patients were divided into two groups according to the grade of preoperative MR: none-to-mild (MR 0-II) or moderate-to-severe (MR III-IV). Results Following 1:1 propensity score matching, each group consisted of 914 patients. Incidence of postoperative temporary right ventricular support, reoperation for bleeding, and dialysis was similar. MR III-IV demonstrated shorter median ICU stay (14 d [6; 27.8] vs 10 d [5; 22], p = 0.004) and ventilation time (72 h [22, 320] vs 31 h [18, 150], p < 0.001). Mortality was lower for MR III-IV patients (SHR 0.66, 95% CI: 0.59–0.73, p < 0.001). The 1-year survival was 68.1% (95% CI: 65.1–71.3%) in MR 0-II and 75% (95% CI: 72.1–78%) in MR III-IV. A lower incidence of total complications (OR 0.93 [0.89–0.98], p = 0.003) and trend towards a lower risk of neurological dysfunction (SHR 0.79; 95% CI: 0.61–1.01, p = 0.063) and sustained ventricular tachycardia (OR 0.93 [0.54–1.03], p = 0.074) were demonstrated for MR III-IV. The risk of fatal stroke and pump thrombosis was similar. Conclusion Moderate-to-severe MR in patients undergoing LVAD implantation is associated with better mid-term survival and lower incidence of total major adverse events and complications. The incidence of severe postoperative complications including fatal stroke and device thrombosis was similar.

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Transcatheter Mitral Valve Repair for Severe, Symptomatic Mitral Regurgitation in Patients with Left Ventricular Assist Devices

Cited by 2 publications

References 14 publications

Transcatheter valvular therapies in patients with left ventricular assist devices

Transcatheter valvular therapies in patients with left ventricular assist devices

Impact of preoperative mitral regurgitation on left ventricular assist device patients: propensity score-matched analysis of the EUROMACS dataset

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