Impact of Post-Implant Mitral Regurgitation on Durable Left Ventricular Assist Device Outcomes

Document Type

Article

Publication Date

6-24-2025

Publication Title

The Journal of thoracic and cardiovascular surgery

Abstract

BACKGROUND: The association of significant post-implant mitral regurgitation (PI-MR) with left ventricular assist device (LVAD) outcomes remains controversial. We investigated PI-MR in the setting of contemporary LVAD therapy.

METHODS: The Society of Thoracic Surgeons (STS) Intermacs National Database was queried and identified 2,858 patients with a fully magnetically levitated centrifugal flow LVAD implanted from 2017-2021 who met study inclusion and exclusion criteria. Kaplan-Meir methodology and Cox proportional hazard modeling were used to evaluate the long-term impact of PI-MR on post-LVAD outcomes conditional on surviving 3 months post-LVAD implant. Significant PI-MR was defined as moderate-severe mitral regurgitation (MR) at the 1 or 3-month follow-up echocardiogram.

RESULTS: There were 340 patients with significant PI-MR and 2,518 without PI-MR following LVAD implant. Those with significant PI-MR were younger (53.2 vs 57.7 yrs, P< 0.001), more likely to have a non-ischemic cardiomyopathy etiology of heart failure (66.5% vs. 51.5%, p< .0001), preoperative moderate-severe tricuspid regurgitation (51.5% vs 37.6%, p< .001), and concomitant tricuspid valve replacement/repair (17.1% vs 9.4%, P< .001). Of those with preoperative significant MR, 17% (n=274) had significant PI-MR. Significant PI-MR was associated with worse 2-year survival (88.3% vs 79.5%, p=.008), risk for readmission (HR 1.19, p =.032) and subsequent renal failure (HR 1.84, p=.014).

CONCLUSIONS: Significant PI-MR following contemporary LVAD implant adversely impacts long-term survival and readmission. Strategies to prevent or intervene upon significant PI-MR require further investigation.

PubMed ID

40571187

ePublication

ePub ahead of print

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