Impact of severe mitral regurgitation on postoperative outcome after durable left-ventricular assist device implantation

Background Mitral valve regurgitation (MR) is a common finding in patients with end-stage heart failure. The aim of the study was to analyze the impact of preoperative moderate-to-severe MR on postoperative outcomes and survival after durable left-ventricular assist device (LVAD) implantation. Methods From August 2010 to May 2021, 246 patients underwent a durable LVAD implantation. We stratified the patients into two groups: Group A (n = 109) presented with MR 0-I degrees, and Group B presented with MR II-III degrees (n = 137). MR II-III degrees was defined according to the current recommendations (i.e., vena contracta >= 7 mm, regurgitation volume >= 30 ml or effective regurgitation orifice area >= 20 mm(2)). Results Significantly more patients in Group B suffered from pulmonary hypertension and presented with chronic obstructive lung disease. We observed significantly higher rates of tricuspid regurgitation (TR) II-III degrees in Group B (76.1%) versus Group A (14.8%) (p < 0.001) and TR III degrees in Group B (30.4%) versus Group A (3.7%) (p < 0.001). There was no difference in the incidence of right heart failure between the groups. Within our cohort, the in-hospital, 1-year, 3-year, and 5-year mortality was 22.4%, 32.1%, 50.7%, and 64.4%, respectively. Group B showed significantly worse overall survival (p = 0.05). Patients with preoperative TR II-III degrees had a significantly worse survival than those with TR 0-I degrees (p = 0.048). In patients presenting with MR II-III degrees, we discovered that TR III degrees seems to predict both in-hospital and mid-term mortality. Conclusion MR II-III degrees negatively affects the outcomes in patients requiring LVAD implantation. Persisting MR II-III degrees is an independent predictor of mortality. Patients with concomitant preoperative TR II-III degrees are at increased risk of developing postoperative major adverse events. Addressing the MR might be considered for these patients.