Hemodynamic Effects of Concomitant Mitral Valve Surgery and Left Ventricular Assist Device Implantation

Imamura, Teruhiko; Nnanabu, J.; Rodgers, D.; Raikehlkar, J.; Kalantar, Sara; Smith, Bryan; Nguyen, Ann; Chung, B.; Narang, Nikhil; Ota, Takeyoshi; Song, Tae Ho; Burkhoff, Daniel; Jeevanandam, Valluvan; Kim, Gene; Sayer, Gabriel; Uriel, Nir

doi:10.1097/mat.0000000000000999

Cited by 11 publications

(5 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Repair of mitral valve regurgitation has been shown to improve hemodynamic parameters (pulmonary hypertension, pulmonary vascular resistance) and hospital readmission rates after LVAD implantation. However, no survival benefit could be found (4,8,9). One-year survival here was comparable, with 72% vs. 60% (P=0.81), but still worse than what we achieved in our patients.…”

Section: Discussioncontrasting

confidence: 78%

“…It remains controversial whether issues other than more than mild aortic valve regurgitation or intracardiac shunts [both Class I indications for concomitant surgery according to the International Society of Heart and Lung Transplantation (ISHLT) guidelines (6)] should be addressed at the time of LVAD implantation. Multiple studies have shown contrary results with both adverse effects and improvement of outcomes in terms of right ventricular (RV) function, length of intensive care unit and hospital stay, catecholamine dependency, mortality and more, after LVAD and concomitant cardiac surgery (7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Concomitant cardiac surgery procedures during left ventricular assist device implantation: single-centre experience

Riebandt

Schaefer

Wiedemann

et al. 2021

Ann Cardiothorac Surg

View full text Add to dashboard Cite

Background: Additional cardiac pathologies including tricuspid or mitral valve regurgitation are common in left ventricular assist device (LVAD) recipients and whether to address them remains controversial. We present our institutional outcomes of concomitant cardiac procedures, other than temporary right ventricular (RV) support, at the time of LVAD implantation. Methods: From 03/2006 to 06/2020, 352 adult patients {median age 60 [interquartile range (IQR): 52-66] years; INTERMACS level 1 29%; INTERMACS level 2 17%; INTERMACS level 3 23%, INTERMACS level 4-6 31%; male 86%} underwent continuous-flow LVAD [Medtronic HVAD ® (HVAD) 50%; Abbott HeartMate II TM (HMII) 17%; Abbott HeartMate 3 TM (HM3) 33%] implantation. Concomitant valvular procedures were performed in 86 patients (24%) and the majority of patients received the LVAD as bridge to candidacy (BTC) for transplant (74%). Primary study endpoints were short-and mid-term mortality, as well as need for temporary RV support.Results: Tricuspid valve annuloplasty was the most frequent concomitant procedure (77%), followed by aortic valve replacements (AVRs) or Park's stitch (33%). Temporary RV support was common in the study cohort (35%) using either extracorporeal life support (ECLS, 37%) or a temporary RV assist device (RVAD, 63%). A less invasive (LIS) implantation technique was pursued in 12%. Thirty-day mortality was comparable between those with and without concomitant surgery (4% vs. 6%, P=0.426). In-hospital mortality was significantly higher for additional interventions (22% vs. 14%, P=0.05), whereas one-year survival was similar (71% vs. 79%, P=0.106).Conclusions: Concomitant cardiac procedures, especially tricuspid and aortic valve surgery, are frequent but are associated with a higher perioperative morbidity and mortality.

show abstract

Section: Discussioncontrasting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Concomitant cardiac surgery procedures during left ventricular assist device implantation: single-centre experience

Riebandt

Schaefer

Wiedemann

et al. 2021

Ann Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…10 A recent study by Imamura et al reported increase in pulmonary pressure with concomitant MV surgeries, despite having higher CO and better response of CO at incremental LVAD speed. 21 With the current evidence, it is still unclear whether mitral valve correction for severe MR should be performed at time of cfLVAD implantation.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

“…At present, a number of centers perform LVAD implantation with concomitant mitral valve surgery. [6][7][8][9][10] The resolution of functional MR in LVAD patients has been detected across all grades of severity, and has been reported for 6-month, 11,12 18-month, 13 and 3-year (y) followups. 14 However, these studies investigated the HeartMate II or Heartware ventricular assist device (HVAD), and in 8%-28% of the patients MR was still detected postoperatively after LVAD implantation.…”

Section: Introductionmentioning

confidence: 92%

“…After LVAD implantation, the size of the left ventricle chamber decreases because of mechanical unloading, 4,5 which could lead to a reduction of MR severity. At present, a number of centers perform LVAD implantation with concomitant mitral valve surgery 6‐10 …”

Section: Introductionmentioning

confidence: 99%

Validation of mitral regurgitation reversibility in patients with HeartMate 3 LVAD implantation

et al. 2021

View full text Add to dashboard Cite

The resolution of functional mitral valve regurgitation (MR) in patients awaiting left ventricular assist device (LVAD) implantation is discussed controversially. The present study analyzed MR and echocardiographic parameters of the third-generation LVAD HeartMate 3 (HM3) over 3 years. Of 135 LVAD patients (with severe MR, n = 33; with none, mild, or moderate MR, n = 102), data of transthoracic echocardiography were included preoperatively to LVAD implantation, up to 1 month postoperatively, and at 1, 2, and 3 years after LVAD implantation. Demographic data and clinical characteristics were collected. Severe MR was reduced immediately after LVAD implantation in all patients. The echocardiographic parameters left ventricular end-diastolic diameter (P < .001), right ventricular end-diastolic diameter (P < .001), tricuspid annular plane systolic excursion (P < .001), and estimated pulmonary artery pressure (P < .001) decreased after HM3 implantation independently from the grade of MR prior to implantation and remained low during the 2 years follow-up period. Following LVAD implantation, right heart failure, ventricular arrhythmias, ischemic stroke as well as pump thrombosis and bleeding events were comparable between the groups. The incidences of death and cardiac death did not differ between the patient groups. Furthermore, the Kaplan-Meier analysis showed that survival was comparable between the groups (P = .073). HM3 implantation decreases preoperative severe MR immediately after LVAD implantation. This effect is long-lasting in most patients and reinforces the LVAD implantation without MR surgery. The complication rates and survival were comparable between patients with and without severe MR.

show abstract

Hemodynamic Effects of Concomitant Mitral Valve Surgery and Left Ventricular Assist Device Implantation

Cited by 11 publications

References 31 publications

Concomitant cardiac surgery procedures during left ventricular assist device implantation: single-centre experience

Concomitant cardiac surgery procedures during left ventricular assist device implantation: single-centre experience

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

Validation of mitral regurgitation reversibility in patients with HeartMate 3 LVAD implantation

Contact Info

Product

Resources

About