Uncorrected pre-operative mitral valve regurgitation is not associated with adverse outcomes after continuous-flow left ventricular assist device implantation.

Authors

• John M Stulak
• Vakhtang Tchantchaleishvili
• Nicholas A Haglund
• Mary E Davis
• John A Schirger
• Jennifer A Cowger
• Palak Shah
• Keith D Aaronson
• Francis D Pagani
• Simon Maltais

Publication/Presentation Date

5-1-2015

Abstract

BACKGROUND: Mitral valve regurgitation (MR) is prevalent in patients with heart failure. Because very few data exist examining the influence of significant pre-operative MR on outcomes after left ventricular assist device (LVAD) implantation, we evaluate our experience.

METHODS: Between October 1996 and August 2013, 756 patients underwent primary LVAD implantation at our institutions. Of these, 508 patients received a continuous-flow LVAD and represent the contemporary cohort for this analysis. Devices implanted included the HeartMate II in 410 patients (81%) and HeartWare HVAD in 98 patients (19%). Based on availability of pre-operative echocardiography, 491 patients were divided into 2 study groups according to degree of pre-operative MR; 189 patients (39%) had moderate to severe or greater MR (MR group), and 302 (61%) had less than moderate to severe MR (less MR group). Median age at operation (60 years in MR group vs 58 years in less MR group, p = 0.19), male sex (78% in MR group vs 81% in less MR group, p = 0.42), and ischemic etiology (46% in MR group vs 51% in less MR group, p = 0.35) were similar between groups.

RESULTS: There were 40 early deaths (7.9%), and follow-up was available in all 468 early survivors for 641 patient-years of support. Patients in the MR group had higher late survival (2 years, 75%; 4 years, 65%) compared with patients in the less MR group (2 years, 66%; 4 years, 48%; p < 0.04). Cox proportional hazards model confirmed the independent interaction between MR and late survival (hazard ratio 0.62, p = 0.04).

CONCLUSIONS: There was improved survival in patients with severe pre-operative MR after continuous-flow LVAD implantation in our cohort. These findings may lend insight into the possible lack of value of addressing significant MR at the time of LVAD implantation.

Volume

34

Issue

5

First Page

718

Last Page

723

ISSN

1557-3117

Published In/Presented At

Stulak, J. M., Tchantchaleishvili, V., Haglund, N. A., Davis, M. E., Schirger, J. A., Cowger, J. A., Shah, P., Aaronson, K. D., Pagani, F. D., & Maltais, S. (2015). Uncorrected pre-operative mitral valve regurgitation is not associated with adverse outcomes after continuous-flow left ventricular assist device implantation. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 34(5), 718–723. https://doi.org/10.1016/j.healun.2014.11.023

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

25697807

Department(s)

Administration and Leadership

Document Type

Article