Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation

Amit Pawale, Shinobu Itagaki, Aditya Parikh, Sean P. Pinney, David H. Adams, Anelechi C. Anyanwu*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: The management of severe mitral regurgitation (MR) at the time of left ventricular assist device (LVAD) implantation is controversial. We adopted an approach of systematic repair of severe MR at the time of LVAD implantation and report our experience. Methods: We performed mitral valve repair (MVr) on 78 consecutive patients with severe MR undergoing LVAD implantation at our institution between 2013 and 2017. We compared data on these patients to 28 historical controls with severe MR from the immediate preceding period between 2011 and 2013 where the MR was not treated, using Cox modeling and propensity score methods. Median follow-up time was 17.7 months. Results: Patients who underwent MVr were younger than those who did not (non-MVr group) (55 vs 63 years; P =.006), but otherwise had similar preoperative characteristics. The incidence of 30-day mortality (2.6% vs 3.6%; P =.78) and other early major adverse events was similar in both groups. At 3 months, no patient in the MVr group had more than mild MR compared with 7 patients (29%) in the non-MVr group (P <.001). Cardiac catheterization done 3 to 6 months after surgery showed tendency toward greater reduction from preoperative pulmonary artery systolic pressure in the MVr group compared with the non-MVr group (−20 vs −13 mm Hg; P =.10). The cumulative incidence of readmission due to congestive heart failure at 2 years was lower in the MVr group than in non-MVr group (7.1% vs 19.7%; adjusted hazard ratio, 0.18; 95% confidence interval, 0.04-0.76; P =.02). Conclusions: Concurrent MVr at the time of LVAD implantation can be done safely without increase in perioperative adverse events. MVr may be associated with better reduction in severity of MR and may have potential benefit in terms of reduction in readmissions for heart failure.

Original languageEnglish (US)
Pages (from-to)1841-1848.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume157
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Heart-Assist Devices
Mitral Valve Insufficiency
Mitral Valve
Heart Failure
Propensity Score
Incidence
Cardiac Catheterization
Pulmonary Artery
Confidence Intervals
Blood Pressure
Mortality

Keywords

  • left ventricular assist device
  • mitral regurgitation
  • mitral valve repair

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Pawale, Amit ; Itagaki, Shinobu ; Parikh, Aditya ; Pinney, Sean P. ; Adams, David H. ; Anyanwu, Anelechi C. / Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation. In: Journal of Thoracic and Cardiovascular Surgery. 2019 ; Vol. 157, No. 5. pp. 1841-1848.e1.
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title = "Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation",
abstract = "Background: The management of severe mitral regurgitation (MR) at the time of left ventricular assist device (LVAD) implantation is controversial. We adopted an approach of systematic repair of severe MR at the time of LVAD implantation and report our experience. Methods: We performed mitral valve repair (MVr) on 78 consecutive patients with severe MR undergoing LVAD implantation at our institution between 2013 and 2017. We compared data on these patients to 28 historical controls with severe MR from the immediate preceding period between 2011 and 2013 where the MR was not treated, using Cox modeling and propensity score methods. Median follow-up time was 17.7 months. Results: Patients who underwent MVr were younger than those who did not (non-MVr group) (55 vs 63 years; P =.006), but otherwise had similar preoperative characteristics. The incidence of 30-day mortality (2.6{\%} vs 3.6{\%}; P =.78) and other early major adverse events was similar in both groups. At 3 months, no patient in the MVr group had more than mild MR compared with 7 patients (29{\%}) in the non-MVr group (P <.001). Cardiac catheterization done 3 to 6 months after surgery showed tendency toward greater reduction from preoperative pulmonary artery systolic pressure in the MVr group compared with the non-MVr group (−20 vs −13 mm Hg; P =.10). The cumulative incidence of readmission due to congestive heart failure at 2 years was lower in the MVr group than in non-MVr group (7.1{\%} vs 19.7{\%}; adjusted hazard ratio, 0.18; 95{\%} confidence interval, 0.04-0.76; P =.02). Conclusions: Concurrent MVr at the time of LVAD implantation can be done safely without increase in perioperative adverse events. MVr may be associated with better reduction in severity of MR and may have potential benefit in terms of reduction in readmissions for heart failure.",
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Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation. / Pawale, Amit; Itagaki, Shinobu; Parikh, Aditya; Pinney, Sean P.; Adams, David H.; Anyanwu, Anelechi C.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 157, No. 5, 01.05.2019, p. 1841-1848.e1.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation

AU - Pawale, Amit

AU - Itagaki, Shinobu

AU - Parikh, Aditya

AU - Pinney, Sean P.

AU - Adams, David H.

AU - Anyanwu, Anelechi C.

PY - 2019/5/1

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N2 - Background: The management of severe mitral regurgitation (MR) at the time of left ventricular assist device (LVAD) implantation is controversial. We adopted an approach of systematic repair of severe MR at the time of LVAD implantation and report our experience. Methods: We performed mitral valve repair (MVr) on 78 consecutive patients with severe MR undergoing LVAD implantation at our institution between 2013 and 2017. We compared data on these patients to 28 historical controls with severe MR from the immediate preceding period between 2011 and 2013 where the MR was not treated, using Cox modeling and propensity score methods. Median follow-up time was 17.7 months. Results: Patients who underwent MVr were younger than those who did not (non-MVr group) (55 vs 63 years; P =.006), but otherwise had similar preoperative characteristics. The incidence of 30-day mortality (2.6% vs 3.6%; P =.78) and other early major adverse events was similar in both groups. At 3 months, no patient in the MVr group had more than mild MR compared with 7 patients (29%) in the non-MVr group (P <.001). Cardiac catheterization done 3 to 6 months after surgery showed tendency toward greater reduction from preoperative pulmonary artery systolic pressure in the MVr group compared with the non-MVr group (−20 vs −13 mm Hg; P =.10). The cumulative incidence of readmission due to congestive heart failure at 2 years was lower in the MVr group than in non-MVr group (7.1% vs 19.7%; adjusted hazard ratio, 0.18; 95% confidence interval, 0.04-0.76; P =.02). Conclusions: Concurrent MVr at the time of LVAD implantation can be done safely without increase in perioperative adverse events. MVr may be associated with better reduction in severity of MR and may have potential benefit in terms of reduction in readmissions for heart failure.

AB - Background: The management of severe mitral regurgitation (MR) at the time of left ventricular assist device (LVAD) implantation is controversial. We adopted an approach of systematic repair of severe MR at the time of LVAD implantation and report our experience. Methods: We performed mitral valve repair (MVr) on 78 consecutive patients with severe MR undergoing LVAD implantation at our institution between 2013 and 2017. We compared data on these patients to 28 historical controls with severe MR from the immediate preceding period between 2011 and 2013 where the MR was not treated, using Cox modeling and propensity score methods. Median follow-up time was 17.7 months. Results: Patients who underwent MVr were younger than those who did not (non-MVr group) (55 vs 63 years; P =.006), but otherwise had similar preoperative characteristics. The incidence of 30-day mortality (2.6% vs 3.6%; P =.78) and other early major adverse events was similar in both groups. At 3 months, no patient in the MVr group had more than mild MR compared with 7 patients (29%) in the non-MVr group (P <.001). Cardiac catheterization done 3 to 6 months after surgery showed tendency toward greater reduction from preoperative pulmonary artery systolic pressure in the MVr group compared with the non-MVr group (−20 vs −13 mm Hg; P =.10). The cumulative incidence of readmission due to congestive heart failure at 2 years was lower in the MVr group than in non-MVr group (7.1% vs 19.7%; adjusted hazard ratio, 0.18; 95% confidence interval, 0.04-0.76; P =.02). Conclusions: Concurrent MVr at the time of LVAD implantation can be done safely without increase in perioperative adverse events. MVr may be associated with better reduction in severity of MR and may have potential benefit in terms of reduction in readmissions for heart failure.

KW - left ventricular assist device

KW - mitral regurgitation

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