TY - JOUR
T1 - Concomitant mitral valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices
T2 - An INTERMACS database analysis
AU - Robertson, Jason O.
AU - Naftel, David C.
AU - Myers, Susan L.
AU - Tedford, Ryan J.
AU - Joseph, Susan M.
AU - Kirklin, James K.
AU - Silvestry, Scott C.
N1 - Funding Information:
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.
Publisher Copyright:
© 2018
PY - 2018/1
Y1 - 2018/1
N2 - 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.
AB - 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.
KW - left ventricular assist device
KW - mitral regurgitation
KW - mitral valve
KW - mitral valve repair
KW - mitral valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85035093850&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85035093850&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2017.09.016
DO - 10.1016/j.healun.2017.09.016
M3 - Article
C2 - 29150326
AN - SCOPUS:85035093850
SN - 1053-2498
VL - 37
SP - 79
EP - 88
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 1
ER -