Resolution of Mitral Regurgitation With Left Ventricular Assist Device Support
Goodwin M, Nemeh HW, Borgi J, Paone G, and Morgan JA. Resolution of mitral regurgitation with left ventricular assist device support. Ann Thorac Surg 2017; 104(3):811-818.
The Annals of thoracic surgery
BACKGROUND: Cardiac valve disease is common in patients with end-stage heart failure undergoing left ventricular assist device implantation (LVAD). The aim of this study was to determine if preoperative mitral regurgitation (MR) affects outcomes and hemodynamics in patients after LVAD implantation.
METHODS: From March 2006 through May 2015, 238 consecutive patients underwent LVAD implantation. Patient cohorts included less than moderate to severe MR (< moderate-severe, n = 195) and greater than or equal to moderate to severe MR (≥ moderate-severe, n = 43). Demographics, operative characteristics, postoperative outcomes, hemodynamic and echocardiographic data, and resolution of MR were compared at 30 and 180 days post-LVAD.
RESULTS: Significant hemodynamic improvements were seen in central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, cardiac index, left ventricular ejection fraction, and left ventricular end-diastolic diameter, irrespective of preoperative MR severity. Significant resolution of MR occurred across both cohorts, with only 4 of 168 (2.4%) patients with ≥ moderate-severe MR at 180 days post-LVAD. There were no differences in complications or survival between MR severity cohorts postoperatively.
CONCLUSIONS: LVAD implantation unloads the left ventricle to promote left ventricle reverse remodeling and correct functional MR across all severity levels. The resolution of MR is sustained at 180 days post-LVAD. These results coupled with no survival difference with uncorrected MR between < moderate-severe MR and ≥ moderate-severe MR makes concomitant mitral valve repair or replacement at the time of LVAD implantation unnecessary.
Medical Subject Headings
Echocardiography; Female; Heart Valve Prosthesis Implantation; Heart-Assist Devices; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Retrospective Studies; Treatment Outcome; Ventricular Function, Left; Ventricular Remodeling