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

Abstract

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.

Left ventricular assist device implantation and concomitant mitral valve surgery: A systematic review and meta‐analysis

“…8,[19][20][21][22] This is believed to be a result of improving the haemodynamics of the left ventricle thus lowering the left ventricular enddiastolic diameter (LVEDD) and therefore reducing the severity of MR. 23 It is most likely because of this, that we did not find increased survival in the LVAD + MVR group. Whilst our recently published meta-analysis showed that the degree of pre-operative MR does not appear to affect mortality in patients receiving LVAD, 24 the same cannot be said for post-operative MR with several studies linking it to worse clinical outcomes, 25,26 a conclusion which was also reached by the recently published study by Loforte and colleagues. 27 Interestingly, the study by Loforte et al 27 surprisingly demonstrates that LVAD implantation in patients with significant preoperative MR without concomitant mitral valve surgery leads to better survival and morbidity outcomes compared to those with mild or no MR.…”