Right ventricular function and residual mitral regurgitation after left ventricular assist device implantation determines the incidence of right heart failure
Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved..
BACKGROUND: The effect of significant mitral regurgitation (MR) on outcomes after continuous flow left ventricular assist device (cfLVAD) implantation remains unclear.
METHODS: We performed a retrospective review of prospectively collected data from 159 patients with preoperative severe MR who underwent cfLVAD implantation (2003-2017). Two-step cluster analysis using the log-likelihood distance for post-cfLVAD implantation parameters, which included right ventricular (RV) dysfunction, MR severity, and tricuspid regurgitation (TR) severity. Post-cfLVAD implantation echocardiographic parameters were obtained within the first month.
RESULTS: Cluster analysis resulted in 3 groups. Group 1 (n = 67) had mild or less MR with moderate-severe RV dysfunction (RVD). Group 2 (n = 43) had moderate-severe MR with moderate-severe RVD. Group 3 (n = 49) had moderate MR with mild RVD. Group 2 had the largest proportion with Interagency Registry for Mechanically Assisted Circulatory Support score of 1 (30.2%) and 2 (41.9%). They were more likely to undergo temporary mechanical circulatory support (18.6%) and tricuspid valve procedure (62.8%). Group 2 had the highest rate of stroke (30.2%; P = .02), hemolysis (39.5%; P = .01), device thrombosis (30%; P = .01), and worst survival (46.5%; P = .01). Survival at 5 years for groups 1, 2, and 3 were 56.0%, 17.6%, and 55.8%. Regression analysis of the entire population showed that greater MR severity after cfLVAD was associated with RV failure (P < .05; odds ratio, 1.6) and RV assist device use (P = .09; odds ratio, 1.6). After excluding tricuspid valve repairs, MR severity had a positive correlation with TR severity (R = 0.33; P < .01).
CONCLUSIONS: After cfLVAD implantation, moderate-severe MR and RVD predicted RV failure. Patients with preoperative moderate-severe MR and TR coupled with moderate-severe RVD might benefit the most from mitral and tricuspid valve intervention.
| Errataetall: |
CommentIn: J Thorac Cardiovasc Surg. 2020 Mar;159(3):906-907. - PMID 31128905 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:159 |
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| Enthalten in: |
The Journal of thoracic and cardiovascular surgery - 159(2020), 3 vom: 05. März, Seite 897-905.e4 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Tang, Paul C [VerfasserIn] |
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| Links: |
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| Themen: |
Clinical outcomes |
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| Anmerkungen: |
Date Completed 23.03.2020 Date Revised 08.05.2020 published: Print-Electronic CommentIn: J Thorac Cardiovasc Surg. 2020 Mar;159(3):906-907. - PMID 31128905 Citation Status MEDLINE |
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| doi: |
10.1016/j.jtcvs.2019.03.089 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM297199161 |
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| 100 | 1 | |a Tang, Paul C |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Right ventricular function and residual mitral regurgitation after left ventricular assist device implantation determines the incidence of right heart failure |
| 264 | 1 | |c 2020 | |
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| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 23.03.2020 | ||
| 500 | |a Date Revised 08.05.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: J Thorac Cardiovasc Surg. 2020 Mar;159(3):906-907. - PMID 31128905 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: The effect of significant mitral regurgitation (MR) on outcomes after continuous flow left ventricular assist device (cfLVAD) implantation remains unclear | ||
| 520 | |a METHODS: We performed a retrospective review of prospectively collected data from 159 patients with preoperative severe MR who underwent cfLVAD implantation (2003-2017). Two-step cluster analysis using the log-likelihood distance for post-cfLVAD implantation parameters, which included right ventricular (RV) dysfunction, MR severity, and tricuspid regurgitation (TR) severity. Post-cfLVAD implantation echocardiographic parameters were obtained within the first month | ||
| 520 | |a RESULTS: Cluster analysis resulted in 3 groups. Group 1 (n = 67) had mild or less MR with moderate-severe RV dysfunction (RVD). Group 2 (n = 43) had moderate-severe MR with moderate-severe RVD. Group 3 (n = 49) had moderate MR with mild RVD. Group 2 had the largest proportion with Interagency Registry for Mechanically Assisted Circulatory Support score of 1 (30.2%) and 2 (41.9%). They were more likely to undergo temporary mechanical circulatory support (18.6%) and tricuspid valve procedure (62.8%). Group 2 had the highest rate of stroke (30.2%; P = .02), hemolysis (39.5%; P = .01), device thrombosis (30%; P = .01), and worst survival (46.5%; P = .01). Survival at 5 years for groups 1, 2, and 3 were 56.0%, 17.6%, and 55.8%. Regression analysis of the entire population showed that greater MR severity after cfLVAD was associated with RV failure (P < .05; odds ratio, 1.6) and RV assist device use (P = .09; odds ratio, 1.6). After excluding tricuspid valve repairs, MR severity had a positive correlation with TR severity (R = 0.33; P < .01) | ||
| 520 | |a CONCLUSIONS: After cfLVAD implantation, moderate-severe MR and RVD predicted RV failure. Patients with preoperative moderate-severe MR and TR coupled with moderate-severe RVD might benefit the most from mitral and tricuspid valve intervention | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Video-Audio Media | |
| 650 | 4 | |a clinical outcomes | |
| 650 | 4 | |a cluster analysis | |
| 650 | 4 | |a echocardiography | |
| 650 | 4 | |a left ventricular assist device | |
| 650 | 4 | |a right ventricular assist device | |
| 650 | 4 | |a right ventricular failure | |
| 700 | 1 | |a Haft, Jonathan W |e verfasserin |4 aut | |
| 700 | 1 | |a Romano, Matthew A |e verfasserin |4 aut | |
| 700 | 1 | |a Bitar, Abbas |e verfasserin |4 aut | |
| 700 | 1 | |a Hasan, Reema |e verfasserin |4 aut | |
| 700 | 1 | |a Palardy, Maryse |e verfasserin |4 aut | |
| 700 | 1 | |a Wu, Xiaoting |e verfasserin |4 aut | |
| 700 | 1 | |a Aaronson, Keith D |e verfasserin |4 aut | |
| 700 | 1 | |a Pagani, Francis D |e verfasserin |4 aut | |
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