Impact of Pre-Existing Mitral Regurgitation Following Left Ventricular Assist Device Implant

Coyan, Garrett N.; Pierce, Brian R.; Rhinehart, Zachary; Ruppert, Kristen M.; Katz, William E.; Kilic, Arman; Kormos, Robert L.; Sciortino, Christopher M.

doi:10.1053/j.semtcvs.2020.12.007

Cited by 4 publications

(7 citation statements)

References 18 publications

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“…In the absence of mitral intervention, 93% of patients showed resolution of MR at 30 days. 165 In addition, a sub-analysis of MOMENTUM 3 including patients who had preoperative severe MR demonstrated residual MR in only 6.2% of patients with Heart-Mate 3. 166 In conclusion, overall data support no intervention for pre-existing severe MR.…”

Section: Left Ventricular Assist Devices and Heart Transplantationmentioning

confidence: 99%

“…In a recent study, there was no significant difference in mortality following MCS in those with or without pre‐existing severe MR. In the absence of mitral intervention, 93% of patients showed resolution of MR at 30 days 165 . In addition, a sub‐analysis of MOMENTUM 3 including patients who had preoperative severe MR demonstrated residual MR in only 6.2% of patients with HeartMate 3 166 .…”

Section: Treatmentmentioning

confidence: 99%

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Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology

Chioncel

Adamo

Nikolaou³

et al. 2023

European J of Heart Fail

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Acute heart failure (AHF) represents a broad spectrum of disease states, resulting from the interaction between an acute precipitant and a patient's underlying cardiac substrate and comorbidities. Valvular heart disease (VHD) is frequently associated with AHF. AHF may result from several precipitants that add an acute haemodynamic stress superimposed on a chronic valvular lesion or may occur as a consequence of a new significant valvular lesion. Regardless of the mechanism, clinical presentation may vary from acute decompensated heart failure to cardiogenic shock. Assessing the severity of VHD as well as the correlation between VHD severity and symptoms may be difficult in patients with AHF because of the rapid variation in loading conditions, concomitant destabilization of the associated comorbidities and the presence of combined valvular lesions. Evidence‐based interventions targeting VHD in settings of AHF have yet to be identified, as patients with severe VHD are often excluded from randomized trials in AHF, so results from these trials do not generalize to those with VHD. Furthermore, there are not rigorously conducted randomized controlled trials in the setting of VHD and AHF, most of the data coming from observational studies. Thus, distinct to chronic settings, current guidelines are very elusive when patients with severe VHD present with AHF, and a clear‐cut strategy could not be yet defined. Given the paucity of evidence in this subset of AHF patients, the aim of this scientific statement is to describe the epidemiology, pathophysiology, and overall treatment approach for patients with VHD who present with AHF.

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Section: Left Ventricular Assist Devices and Heart Transplantationmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology

Chioncel

Adamo

Nikolaou³

et al. 2023

European J of Heart Fail

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“…Of these, 340 relevant articles were read in full and assessed according to our inclusion and exclusion criteria. Following critical appraisal, a total of 19 studies [7][8][9][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] incorporating a total of 11 873 patients were included. The studies described outcomes of patients undergoing LVAD implantation with either MR grade 0-I (8819 patients) or II-III (3096 patients).…”

Section: Description Of Studiesmentioning

confidence: 99%

Prognostic value of mitral regurgitation in patients undergoing left ventricular assist device deployment: A systematic review and meta‐analysis

et al. 2023

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BackgroundLeft ventricular assist devices (LVADs) represent an important therapeutic option for patients progressing to end‐stage heart failure. LVAD has previously been shown to have a promising role in improving mitral regurgitation (MR). Nevertheless, the prognostic value of preoperative uncorrected MR in this population remains unclear.MethodsA systematic database search with meta‐analysis was conducted of comparative original articles of patients with preoperative mild MR (Grade 0–I) versus moderate–severe MR (Grade II–III) undergoing LVAD implantation, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to June 2022. Primary outcomes were overall and operative mortality. Secondary outcomes were neurological dysfunction, gastrointestinal bleeding, right heart failure, LVAD thrombosis, and driveline infection.ResultsOur search yielded 2228 relevant studies. A total of 19 studies met the inclusion criteria with a total of 11 873 patients. LVAD caused a statistically significant decrease of 35.9% in the number of patients with moderate–severe MR (grade II–III) postoperatively. No significant difference was observed in terms of overall mortality, operative mortality, GI bleeding, LVAD thrombosis, and driveline infection rates between mild and moderate–severe MR. An increased rate of right heart failure was seen among patients with moderate–severe MR, while lower rates of neurological events were also observed.ConclusionLVAD improves the haemodynamics of the left ventricle, to promote resolution of MR. Nevertheless, the severity of preoperative mitral regurgitation in patients undergoing LVAD deployment does not seem to affect mortality.

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“…The clinical impact of significant residual MR translates most consistently with its influence on increased readmission rates. This is most likely the result of a higher incidence of RVF in those with residual SMR ( 13 , 23 ).…”

Section: Mitral Regurgitation and Its Impact On Left Ventricular Assi...mentioning

confidence: 99%

“…As expected, this correlated closely with the 39–43% incidence of preoperative significant MR in patients undergoing left ventricular assist device (LVAD) implantation ( 11 , 12 ). The large majority (∼94%) of MR in LVAD patients are a result of restricted leaflet motion during systole from tethering (type IIIb) along with components of reduced leaflet motion from thickening and calcification (type IIIa) and annular dilatation (type I) ( 13 ). It should be noted that there are significant challenges in evaluating the burden of preoperative and residual MR given its underlying dynamic nature where MR severity is modulated by conditions such as pump speed, afterload and volume status.…”

Section: Introductionmentioning

confidence: 99%

Role of the mitral valve in left ventricular assist device pathophysiology

Noly

Duggal²,

Jiang³

et al. 2022

Front. Cardiovasc. Med.

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Functional mitral regurgitation (MR) in the setting of heart failure results from progressive dilatation of the left ventricle (LV) and mitral annulus. This leads to leaflet tethering with posterior displacement. Contrary to common assumptions, MR often does not resolve with LVAD decompression of the LV alone. The negative impact of significant (moderate-severe) mitral regurgitation in the LVAD setting is becoming better recognized in terms of its harmful effect on right heart function, pulmonary vascular resistance and hospital readmissions. However, controversies remain regarding the threshold for intervention and management. At present, there are no consensus indications for the repair of significant mitral regurgitation at the time of LVAD implantation due to the conflicting data regarding potential adverse effects of MR on clinical outcomes. In this review, we summarize the current understanding of MR pathophysiology in patients supported with LVAD and potential future management strategies.

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Impact of Pre-Existing Mitral Regurgitation Following Left Ventricular Assist Device Implant

Cited by 4 publications

References 18 publications

Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology

Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology

Prognostic value of mitral regurgitation in patients undergoing left ventricular assist device deployment: A systematic review and meta‐analysis

Role of the mitral valve in left ventricular assist device pathophysiology

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