Total Artificial Heart versus Bi-Ventricular Assist Device: Meta-Analysis of Long-Term Survival and Systematic Review

Abstract

patients (80.9%) with a mean age of 53 years were mainly treated with the Medtronic HVAD device (76%). Baseline characteristics including the severity of LV and RV dysfunction (LVEF 19%, TAPSE 16mm Controlgroup) were comparable between both study-groups. There was no difference regarding preoperative LV dilatation (LVEDD 78mm MR-group vs. LVEDD 75mm Control-group; p=0.67). We found significantly increased parameters of mitral leaflet-tethering prior to LVAD implantation within the MR-group (Tenting-height: 11.5mm vs. 7.5mm; p=0.03; Tenting-area: 244mm 2 vs. 178mm 2 ; p=0.04). Tethering of the anterior mitral leaflet (AML) was particularly increased in the MR-group (p=0.02). 12 months after LVAD implantation patients within the MR-group showed a significantly reduced exercise capacity (6-minute walk test: 293m vs. 439m; p=0.04). Overall survival was significantly impaired in the MR-group in comparison to the Control-group (40% vs. 91%; p=0.002). Conclusion: LVAD recipients with persistent MR despite mechanical unloading showed significant echocardiographic signs of mitral leaflet tethering prior to LVAD implantation. Furthermore, persistent MR 12 months after LVAD implantation was associated with a reduced exercise capacity and an impaired overall survival. If correction of preoperative MR improves post implant survival needs to be shown in future studies.