Jason O Robertson1, David C Naftel2, Susan L Myers2, Ryan J Tedford3, Susan M Joseph4, James K Kirklin2, Scott C Silvestry5. 1. Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri, USA. 2. Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA. 3. Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. 4. Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA. 5. Thoracic Transplant Program, Florida Hospital Transplant Institute, Orlando, Florida, USA. Electronic address: scott.silvestry.md@flhosp.org.
Abstract
BACKGROUND: Management of existing mitral valve (MV) disease in patients undergoing left ventricular assist device (LVAD) implantation remains controversial. METHODS: Among continuous-flow LVAD patients with moderate to severe mitral regurgitation entered into the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database between April 2008 and March 2014 (n = 4,930), outcomes were compared between patients who underwent MV repair (MVr, n = 252), MV replacement (MVR, n = 11) and no MV procedure (no MVP, n = 4,667). Impact on survival was analyzed by stratified actuarial and hazard function multivariable methodology. Post-operative functional capacity and quality of life were assessed. RESULTS: Patients who underwent MVPs had higher pre-operative pulmonary vascular resistance (3.6 ± 2.9 vs 2.9 ± 2.6 Wood units; p = 0.0006) and higher pulmonary artery systolic pressures (55.1 ± 13.8 vs 51.5 ± 14.0 mm Hg; p = 0.0003). Two-year survival was 76% for patients with concomitant MVr, 57% for those with MVR and 71% for those with no MVP (p = 0.15). By multivariable analysis, neither MVr nor MVR affected early or late survival. Although improvements in post-operative functional status as evaluated by 6-minute walk distances were comparable across groups, visual analog score assessments of quality of life suggested a benefit of concomitant MVPs at 1-year post-implant (79.00 ± 1.73 vs 74.45 ± 0.51; p = 0.03), with fewer re-admissions observed for MVP patients (p < 0.0001). CONCLUSIONS: Concomitant MVPs are not associated with increased survival overall. However, MVPs are associated with benefits in terms of reduced hospital re-admission and improved quality of life in select patients.
BACKGROUND: Management of existing mitral valve (MV) disease in patients undergoing left ventricular assist device (LVAD) implantation remains controversial. METHODS: Among continuous-flow LVAD patients with moderate to severe mitral regurgitation entered into the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database between April 2008 and March 2014 (n = 4,930), outcomes were compared between patients who underwent MV repair (MVr, n = 252), MV replacement (MVR, n = 11) and no MV procedure (no MVP, n = 4,667). Impact on survival was analyzed by stratified actuarial and hazard function multivariable methodology. Post-operative functional capacity and quality of life were assessed. RESULTS:Patients who underwent MVPs had higher pre-operative pulmonary vascular resistance (3.6 ± 2.9 vs 2.9 ± 2.6 Wood units; p = 0.0006) and higher pulmonary artery systolic pressures (55.1 ± 13.8 vs 51.5 ± 14.0 mm Hg; p = 0.0003). Two-year survival was 76% for patients with concomitant MVr, 57% for those with MVR and 71% for those with no MVP (p = 0.15). By multivariable analysis, neither MVr nor MVR affected early or late survival. Although improvements in post-operative functional status as evaluated by 6-minute walk distances were comparable across groups, visual analog score assessments of quality of life suggested a benefit of concomitant MVPs at 1-year post-implant (79.00 ± 1.73 vs 74.45 ± 0.51; p = 0.03), with fewer re-admissions observed for MVP patients (p < 0.0001). CONCLUSIONS: Concomitant MVPs are not associated with increased survival overall. However, MVPs are associated with benefits in terms of reduced hospital re-admission and improved quality of life in select patients.
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