Intermacs Analysis of Impact of Significant Post-LVAD Mitral Regurgitation on Outcomes

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Heart Lung Transplant

Keywords

bilirubin, carbohydrate mixture plus electrolytes, adult, adverse device effect, African American, aged, cohort analysis, complication, conference abstract, echocardiography, female, hospital readmission, human, intraaortic balloon pump, left ventricular assist device, major clinical study, male, mitral valve regurgitation, surgery

Abstract

Purpose: Impact of significant post-implant mitral regurgitation (PI-MR) on left ventricular assist device (LVAD) outcomes remains controversial. We investigated the effect of PI-MR from a real-world experience. Methods: Intermacs Database was queried to identify 7,385 patients receiving primary HeartMate 3 implant from 2014-2021. Patients undergoing concomitant mitral valve procedures were excluded. Significant PI-MR following LVAD implant was defined as moderate/severe MR post-implant on 1 or 3-month echocardiogram. Those not surviving 3 months (n=682) and/or without echocardiogram results available (n=781) were excluded. Survival and readmission analysis using log-rank statistics were conditional on 3 month survival. Results: The study cohort consisted of 363 patients with significant PI-MR and 2,744 patients without significant PI-MR. Those with significant PI-MR were younger (53 vs 57 years, P<0.001), more likely to be African American (39% vs 31%, P<0.01), have a higher pre-implant total bilirubin (1.5 vs 1.2 mg/dL) and more likely to have an intra-aortic balloon pump at the time of LVAD implant (35% vs 28%, P<0.01) compared to patients with no PI-MR. Of those with preop significant MR, 17% (n=292) had persistent significant PI-MR. For those with mild or less pre-implant MR, 5% (n=71) developed new significant PI-MR. Patients with significant PI-MR had worse survival at 2 years, conditional upon surviving 3 months (80% vs 87%, P=0.024) and freedom from all-cause readmissions (27% vs 36%, P=0.03). Significant PI-MR also predicted worse conditional mortality based on log-rank statistics (P=0.012, Figure A) and increased readmissions (P=0.004, Figure B). Those patients with significant PI-MR were more likely to have received concomitant tricuspid valve surgery (17% vs 10%, P<0.001). Conclusion: Significant residual MR following LVAD adversely impacts 2-year survival and all-cause readmissions. These data suggest that strategies to reduce the occurrence of PI-MR may improve durable LVAD outcomes. [Formula presented]

Volume

43

Issue

4

First Page

S136

Last Page

S137

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