Predictors and clinical implications of residual mitral regurgitation following left ventricular assist device therapy

Harish Sharma; Boyang Liu; Mengshi Yuan; Iqra Shakeel; Andrew Morley-Smith; Alice Hatch; Joseph Bradley; Colin Chue; Saul G Myerson; Richard Paul Steeds; Sern Lim

doi:10.1136/openhrt-2022-002240

Predictors and clinical implications of residual mitral regurgitation following left ventricular assist device therapy

Harish Sharma^*, Boyang Liu, Mengshi Yuan, Iqra Shakeel, Andrew Morley-Smith, Alice Hatch, Joseph Bradley, Colin Chue, Saul G Myerson, Richard Paul Steeds, Sern Lim

^*Corresponding author for this work

Cardiovascular Sciences

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Abstract

Background: Correction of mitral regurgitation (MR) at the time of left ventricular assist device (LVAD) implantation remains controversial. There is conflicting evidence regarding the clinical impact of residual MR, and studies have not examined whether MR aetiology or right heart function impacts the likelihood of residual MR.

Methods: This is a retrospective single-centre study of 155 consecutive patients with LVAD implantation from January 2011 to March 2020. Exclusion criteria were no MR pre-LVAD (n=8), inaccessible echocardiography (n=9), duplicate records (n=10) and concomitant mitral valve repair (n=1). Statistical analysis was performed using STATA V.16 and SPSS V.24.

Results: Carpentier IIIb MR aetiology was associated with more severe MR pre-LVAD (severe 18/27 (67%) vs non-severe 32/91 (35%), p=0.004) and a higher likelihood of residual MR (8/11 (72%) vs 30/74 (41%), p=0.045). Of 95 patients with significant MR pre-LVAD, 15 (16%) had persistent significant MR, which was associated with higher mortality (p=0.006), post-LVAD right ventricle (RV) dilatation (10/15 (67%) vs 28/80 (35%), p=0.022) and RV dysfunction (14/15 (93%) vs 35/80 (44%), p

Original language	English
Article number	e002240
Number of pages	9
Journal	Open Heart
Volume	10
Issue number	1
DOIs	https://doi.org/10.1136/openhrt-2022-002240
Publication status	Published - 14 Jun 2023

Keywords

Heart-Assist Devices
Mitral Valve Insufficiency
HEART FAILURE

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title = "Predictors and clinical implications of residual mitral regurgitation following left ventricular assist device therapy",

abstract = "Background: Correction of mitral regurgitation (MR) at the time of left ventricular assist device (LVAD) implantation remains controversial. There is conflicting evidence regarding the clinical impact of residual MR, and studies have not examined whether MR aetiology or right heart function impacts the likelihood of residual MR. Methods: This is a retrospective single-centre study of 155 consecutive patients with LVAD implantation from January 2011 to March 2020. Exclusion criteria were no MR pre-LVAD (n=8), inaccessible echocardiography (n=9), duplicate records (n=10) and concomitant mitral valve repair (n=1). Statistical analysis was performed using STATA V.16 and SPSS V.24. Results: Carpentier IIIb MR aetiology was associated with more severe MR pre-LVAD (severe 18/27 (67%) vs non-severe 32/91 (35%), p=0.004) and a higher likelihood of residual MR (8/11 (72%) vs 30/74 (41%), p=0.045). Of 95 patients with significant MR pre-LVAD, 15 (16%) had persistent significant MR, which was associated with higher mortality (p=0.006), post-LVAD right ventricle (RV) dilatation (10/15 (67%) vs 28/80 (35%), p=0.022) and RV dysfunction (14/15 (93%) vs 35/80 (44%), p",

keywords = "Heart-Assist Devices, Mitral Valve Insufficiency, HEART FAILURE",

author = "Harish Sharma and Boyang Liu and Mengshi Yuan and Iqra Shakeel and Andrew Morley-Smith and Alice Hatch and Joseph Bradley and Colin Chue and Myerson, {Saul G} and Steeds, {Richard Paul} and Sern Lim",

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T1 - Predictors and clinical implications of residual mitral regurgitation following left ventricular assist device therapy

AU - Sharma, Harish

AU - Liu, Boyang

AU - Yuan, Mengshi

AU - Shakeel, Iqra

AU - Morley-Smith, Andrew

AU - Hatch, Alice

AU - Bradley, Joseph

AU - Chue, Colin

AU - Myerson, Saul G

AU - Steeds, Richard Paul

AU - Lim, Sern

PY - 2023/6/14

Y1 - 2023/6/14

N2 - Background: Correction of mitral regurgitation (MR) at the time of left ventricular assist device (LVAD) implantation remains controversial. There is conflicting evidence regarding the clinical impact of residual MR, and studies have not examined whether MR aetiology or right heart function impacts the likelihood of residual MR. Methods: This is a retrospective single-centre study of 155 consecutive patients with LVAD implantation from January 2011 to March 2020. Exclusion criteria were no MR pre-LVAD (n=8), inaccessible echocardiography (n=9), duplicate records (n=10) and concomitant mitral valve repair (n=1). Statistical analysis was performed using STATA V.16 and SPSS V.24. Results: Carpentier IIIb MR aetiology was associated with more severe MR pre-LVAD (severe 18/27 (67%) vs non-severe 32/91 (35%), p=0.004) and a higher likelihood of residual MR (8/11 (72%) vs 30/74 (41%), p=0.045). Of 95 patients with significant MR pre-LVAD, 15 (16%) had persistent significant MR, which was associated with higher mortality (p=0.006), post-LVAD right ventricle (RV) dilatation (10/15 (67%) vs 28/80 (35%), p=0.022) and RV dysfunction (14/15 (93%) vs 35/80 (44%), p

AB - Background: Correction of mitral regurgitation (MR) at the time of left ventricular assist device (LVAD) implantation remains controversial. There is conflicting evidence regarding the clinical impact of residual MR, and studies have not examined whether MR aetiology or right heart function impacts the likelihood of residual MR. Methods: This is a retrospective single-centre study of 155 consecutive patients with LVAD implantation from January 2011 to March 2020. Exclusion criteria were no MR pre-LVAD (n=8), inaccessible echocardiography (n=9), duplicate records (n=10) and concomitant mitral valve repair (n=1). Statistical analysis was performed using STATA V.16 and SPSS V.24. Results: Carpentier IIIb MR aetiology was associated with more severe MR pre-LVAD (severe 18/27 (67%) vs non-severe 32/91 (35%), p=0.004) and a higher likelihood of residual MR (8/11 (72%) vs 30/74 (41%), p=0.045). Of 95 patients with significant MR pre-LVAD, 15 (16%) had persistent significant MR, which was associated with higher mortality (p=0.006), post-LVAD right ventricle (RV) dilatation (10/15 (67%) vs 28/80 (35%), p=0.022) and RV dysfunction (14/15 (93%) vs 35/80 (44%), p

KW - Heart-Assist Devices

KW - Mitral Valve Insufficiency

KW - HEART FAILURE

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DO - 10.1136/openhrt-2022-002240

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SN - 2053-3624

VL - 10

JO - Open Heart

JF - Open Heart

IS - 1

M1 - e002240

ER -

Predictors and clinical implications of residual mitral regurgitation following left ventricular assist device therapy

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