Concomitant mitral valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: An INTERMACS database analysis
Article
Robertson, Jason O., Naftel, David C., Myers, Susan L., Tedford, Ryan J., Joseph, Susan M., Kirklin, James K., Silvestry, Scott C.
funding text
S.C.S. is a consultant for Thoratec and HeartWare. The remaining authors have no conflicts of interest to disclose. This project was supported in whole or in part by federal funds from the National Heart, Lung and Blood Institute, National Institutes of Health and Department of Health and Human Services (HHSN268201100025C). These findings were presented orally at the 35th annual meeting and scientific sessions of the International Society for Heart and Lung Transplantation, April 2015, Nice, France.
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. (C) 2018 Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. All rights reserved.