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

Schreiber, Constantin; Dieterlen, Maja‐Theresa; Garbade, Jens; Borger, Michael A.; Sieg, Franz; Spampinato, Ricardo; Dobrovie, Monica; Meyer, Anna

doi:10.1111/aor.14053

Cited by 5 publications

(16 citation statements)

References 39 publications

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“…One exception to this is a paper by Tanaka et al., which concluded that patients who underwent a surgical mitral procedure had improved midterm survival compared to LVAD alone 18 . Several studies have shown that performing the LVAD implantation alone greatly improves MR without the need for additional surgical intervention 8,19–22 . This is believed to be a result of improving the haemodynamics of the left ventricle thus lowering the left ventricular end‐diastolic diameter (LVEDD) and therefore reducing the severity of MR 23 .…”

Section: Discussionmentioning

confidence: 99%

“…18 Several studies have shown that performing the LVAD implantation alone greatly improves MR without the need for additional surgical intervention. 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.…”

Section: Mortality Outcomesmentioning

confidence: 99%

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

Arjomandi Rad,

Fleet,

Zubarevich

et al. 2023

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BackgroundThe management of concomitant valvular lesions in patients undergoing left ventricular assist device (LVAD) implantation remains a topic of debate. This systematic review and meta‐analysis aimed to evaluate the existing evidence on postoperative outcomes following LVAD implantation, with and without concomitant MV surgery.MethodsA systematic database search was conducted as per PRISMA guidelines, of original articles comparing LVAD alone to LVAD plus concomitant MV surgery up to February 2023. The primary outcomes assessed were overall mortality and early mortality, while secondary outcomes included stroke, need for right ventricular assist device (RVAD) implantation, postoperative mitral valve regurgitation, major bleeding, and renal dysfunction.ResultsThe meta‐analysis included 10 studies comprising 32 184 patients. It revealed that concomitant MV surgery during LVAD implantation did not significantly affect overall mortality (OR:0.83; 95% CI: 0.53 to 1.29; p = 0.40), early mortality (OR:1.17; 95% CI: 0.63 to 2.17; p = 0.63), stroke, need for RVAD implantation, postoperative mitral valve regurgitation, major bleeding, or renal dysfunction. These findings suggest that concomitant MV surgery appears not to confer additional benefits in terms of these clinical outcomes.ConclusionBased on the available evidence, concomitant MV surgery during LVAD implantation does not appear to have a significant impact on postoperative outcomes. However, decision‐making regarding MV surgery should be individualized, considering patient‐specific factors and characteristics. Further research with prospective studies focusing on specific patient populations and newer LVAD devices is warranted to provide more robust evidence and guide clinical practice in the management of valvular lesions in LVAD recipients.

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Section: Discussionmentioning

confidence: 99%

Section: Mortality Outcomesmentioning

confidence: 99%

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

Arjomandi Rad,

Fleet,

Zubarevich

et al. 2023

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“…Secondary functional MR resolves in the majority of patients undergoing LVAD implantation [ 1 – 4 ]. The therapeutic approaches orientate on the clinical outcomes and the greatest benefit for the patients, which includes health status analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Mechanical unloading during LVAD therapy improves the mitral valve coaptation through decreased left ventricular dimension and pressure. Thus, the resolution of functional MR in LVAD patients has been detected across all grades of severity [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Health status analysis is comparable in HM3 patients with different preoperative grades of mitral regurgitation

Klaeske,

Schreiber,

Eifert

et al. 2023

J Patient Rep Outcomes

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Background The guidelines for mechanical circulatory support of the International Society for Heart and Lung Transplantation do not recommend the routine replacement or repair of the mitral valve at the time point of left ventricular assist device (LVAD) implantation. We investigated different parameters of health status including exercise capacity, anxiety and depression after LVAD implantation in patients with different preoperative grades of mitral regurgitation (MR). Methods A single-center analysis of health status was performed including 45 patients with HeartMate 3 (HM 3) implantation using the 12-items Short Form Health Survey (SF-12) and the Hospital Anxiety and Depression Score (HADS) questionnaires. The study groups were classified according to echocardiographically defined preoperative grade of MR. The group without severe MR comprised 33 patients; the group with severe MR comprised 12 patients. Results Demographic and preclinical characteristics as well as LVAD complications such as thrombosis and bleeding events were comparable between LVAD patients with severe and not severe MR (p > 0.05). Severe MR resolved in all patients after LVAD implantation and improved to moderate, mild or no MR in both groups in a period ranging from 6 months until 2 years. The analyses of SF-12 questionnaire revealed that the physical (p = 0.44) and mental health (p = 0.64) was comparable. The grade of anxiety (p = 0.34) and depression (p = 0.44) was comparable between the groups. Exercise capacity measured by the 6 min walk test correlated positively with the SF-12-determined physical health (p < 0.01, r = 0.518) and negatively with the HADS anxiety (p = 0.01, r = −0.399) and depression (p < 0.01, r = −0.570) scores. Conclusions Our data showed that the health status is comparable in HM 3 patients with different preoperative MR severities in the post-LVAD period. Preoperative severe MR resolves in the majority of patients early after LVAD implantation and is not associated with concomitant mitral valve repair or replacement at the time of LVAD implantation.

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

Cited by 5 publications

References 39 publications

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

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

Health status analysis is comparable in HM3 patients with different preoperative grades of mitral regurgitation

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

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