Valvular Procedures During Ventricular Assist Device Implantation

Öztürk, Pelin; Engin, Çağatay; Ayik, Fatih; Yağdı, Tahir; Nalbantgil, Sanem; Baysal, Bora E.; Özbaran, Mustafa

doi:10.1016/j.transproceed.2012.05.044

Cited by 9 publications

(9 citation statements)

References 13 publications

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“…Consistent with findings from other studies, concurrent valve procedures did not affect overall mortality or length of intensive care unit or hospital stay. 14,[17][18][19] This study shows no increased mortality for HVAD alone versus HVAD plus AVP. In contrast to our findings, Pal et al 9 previously noted significantly increased mortality in a group of 12 patients undergoing AVP during implantation of an axial-flow cf-LVAD.…”

Section: Discussionmentioning

confidence: 61%

Clinical Outcomes After Implantation of a Centrifugal Flow Left Ventricular Assist Device and Concurrent Cardiac Valve Procedures

et al. 2014

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Background— Cardiac valve procedures are commonly performed concurrently during implantation of left ventricular assist devices, but the added procedural risk has not been studied in detail. Methods and Results— Data from patients receiving the HeartWare Ventricular Assist Device in the ADVANCE bridge to transplant (BTT) trial and continued access protocol were reviewed. Of 382 consecutive patients who completed follow-up between August 2008 and June 2013 (mean time on support 389 days, median 271 days), 262 (68.6%) underwent isolated HeartWare Ventricular Assist Device implantation, 75 (19.6%) a concurrent valve procedure, and 45 (11.8%) concurrent nonvalvular procedures. Of the concurrent valve procedures, 56 were tricuspid, 13 aortic, and 6 mitral. Survival was similar between groups (79% for concurrent valve procedures and 85% for HeartWare Ventricular Assist Device only at 1 year; P =0.33). Concurrent valve procedures were also associated with increased unadjusted early right heart failure (RHF). A multivariable analysis for death and RHF (121 total events) identified female sex (odds ratio=2.0 [95% confidence interval, 1.2–3.3; P =0.0053]) and preimplant tricuspid regurgitation severity (odds ratio=2.9 [95% confidence interval, 1.8–4.8, P <0.0001]) as independent predictors while concurrent tricuspid valve procedures (TVP) were not predictors. Furthermore, patients with significant preimplant tricuspid regurgitation who did not receive a TVP experienced an increased rate of late RHF compared with those who received TVP (0.19 versus 0.05 events per patient-year, respectively; P =0.024). Conclusions— Compared with HeartWare Ventricular Assist Device alone, survival was equivalent for the concurrent valve procedure group. Tricuspid regurgitation severity was the most important predictor of increased postoperative RHF, and concurrent TVP was not an independent predictor of RHF overall. Concurrent TVP may reduce the rate of late RHF for patients with significant preimplant tricuspid insufficiency. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00751972.

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Section: Discussionmentioning

confidence: 61%

Clinical Outcomes After Implantation of a Centrifugal Flow Left Ventricular Assist Device and Concurrent Cardiac Valve Procedures

et al. 2014

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“…Despite the fact that heart transplantation remains the gold standard for treatment of end‐stage heart failure, left ventricular assist device (LVAD) implantation is becoming the most commonly used treatment in these patients. Concomitant valve pathologies are an important issue during LVAD implantation which may affect the early and late survival of patients after implantation . Tricuspid valve repair is indicated in case of moderate‐to‐severe regurgitation and large annulus diameter (≥40 mm) to reduce the risk of right heart failure after implantation (Class IIa, Level of Evidence C) .…”

mentioning

confidence: 99%

Impact of Residual Mitral Regurgitation on Right Ventricular Systolic Function After Left Ventricular Assist Device Implantation

et al. 2016

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Significant mitral regurgitation (MR) is thought to decrease after left ventricular assist device (LVAD) implantation, and therefore repair of mitral valve is not indicated in current practice. However, residual moderate and severe MR leads to pulmonary artery pressure increase, thereby resulting in right ventricular (RV) dysfunction during follow-up. We examined the impact of residual MR on systolic function of the right ventricle by echocardiography after LVAD implantation. This study included 90 patients (mean age: 51.7 ± 10.9 years, 14.4% female) who underwent LVAD implantation (HeartMate II = 21, HeartWare = 69) in a single center between December 2010 and June 2014. Echocardiograms obtained at 3-6 months and over after implantation were analyzed retrospectively. RV systolic function was graded as normal, mild, moderate, and severely depressed. MR (≥moderate) was observed in 43 and 44% of patients at early and late period, respectively. Systolic function of the RV was severely depressed in 16 and 9% of all patients. Initial analysis (mean duration of support 174.3 ± 42.5 days) showed a statistically significant correlation between less MR and improved systolic function of RV (P = 0.01). Secondary echocardiographic analysis (following a mean duration of support of 435.1 ± 203 days) was also statistically significant for MR degree and RV systolic dysfunction (P = 0.008). Residual MR after LVAD implantation may cause deterioration of RV systolic function and cause right-sided heart failure symptoms. Repair of severe MR, in selected patients such as those with severe pulmonary hypertension and depressed RV, may be considered to improve the patient's clinical course during pump support.

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“…Pre-existing native or prosthetic valve pathology does not increase the immediate perioperative risk of LVAD insertion; however, these patients continue to pose a challenge for postoperative management while awaiting transplantation [4]. Concomitant valve surgery during VAD implantation appears to be a reasonable option in end-stage heart failure patients with valvular heart disease [5]. Mitral stenosis causing obstruction to blood flow from left atrium to ventricle needs commissurotomy before LAVD implantation to ensure unobstructed flow to the LAVD.…”

Section: Discussionmentioning

confidence: 99%

“…Although, left atriotomy is more commonly used, trans-septal approach offers better mitral visualization in difficult cases especially small left atrium and re-do surgery [5]. The trans-septal approach is also useful in patients necessitating right atriotomy for concomitant procedures and it facilitates beating-heart mitral valve surgery, because retraction of the atrial wall during the trans-atrial approach often causes aortic insufficiency [6,7].…”

Section: Discussionmentioning

confidence: 99%

Mitral commissurotomy through the left ventricle apical orifice with Heart Ware left ventricular assist device implantation

Mohite

Zych

Popov

et al. 2013

J Cardiothorac Surg

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Diseased, replaced or repaired mitral valve can lead to restricted blood flow to left ventricle and inadequate flow in left ventricular assist device (LVAD). A middle age woman with ‘burnt out’ hypertrophic cardiomyopathy had mitral valve repair for mitral regurgitation. She needed LVAD to support severe decompensating heart failure. Repaired mitral valve posed a risk of restricted flow through the device. Mitral commissurotomy was performed on beating heart through the left ventricular apical hole created for insertion of inflow cannula of LVAD.

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Valvular Procedures During Ventricular Assist Device Implantation

Cited by 9 publications

References 13 publications

Clinical Outcomes After Implantation of a Centrifugal Flow Left Ventricular Assist Device and Concurrent Cardiac Valve Procedures

Clinical Outcomes After Implantation of a Centrifugal Flow Left Ventricular Assist Device and Concurrent Cardiac Valve Procedures

Impact of Residual Mitral Regurgitation on Right Ventricular Systolic Function After Left Ventricular Assist Device Implantation

Mitral commissurotomy through the left ventricle apical orifice with Heart Ware left ventricular assist device implantation

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