Impact of concomitant mitral valve repair for severe mitral regurgitation at the time of continuous-flow left ventricular assist device insertion

被引:20
作者
Sandoval, Elena [1 ]
Singh, Steve K. [2 ]
Carillo, Julius A. [2 ]
Baldwin, Andrew C. W. [1 ]
Ono, Masahiro [1 ]
Anand, Jatin [2 ]
Frazier, O. H. [1 ,2 ]
Mallidi, Hari R. [1 ,2 ]
机构
[1] Texas Heart Inst, Div Cardiothorac Transplantat & Assist Device, Houston, TX 77025 USA
[2] Baylor Coll Med, Div Cardiothorac Transplantat & Circulatory Suppo, Houston, TX 77030 USA
关键词
Mitral regurgitation; Left ventricular assist device; Pulmonary vascular resistance; Heart failure; PULMONARY VASCULAR-RESISTANCE; CARDIAC PROCEDURES; IMPLANTATION; CANDIDATES; OUTCOMES;
D O I
10.1093/icvts/ivx223
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES: Mitral regurgitation (MR) is common in patients with end-stage heart failure. We assessed the effect of performing concomitant mitral valve repair during continuous-flow left ventricular assist device (CF-LVAD) implantation in patients with severe preoperative MR. METHODS: We performed a single-centre, retrospective review of all patients who underwent CF-LVAD implantation between December 1999 and December 2013 (n = 469). Patients with severe preoperative MR (n = 78) were identified and then stratified according to whether they underwent concomitant valve repair. Univariate and survival analyses were performed, and multivariable regression was used to determine predictors of survival. RESULTS: Of the 78 patients with severe MR, 21 underwent valve repair at the time of CF-LVAD implantation (repair group) and 57 did not (non-repair group). A comparison of the 2 groups showed significant differences between groups: INTERMACS I 16.985 vs 9.52%, (P = 0.039), cardiopulmonary bypass time 82.09 vs 109.4 min (P = 0.0042) and the use of HeartMate II 63.16 vs 100% (P = 0.001). Survival analysis suggested trends towards improved survival and a lower incidence of heart failure-related readmissions in the repair group. Multivariable regression analysis showed no significant independent predictors of survival (mitral valve repair: odds ratio 0.4, 95% confidence interval 0.8-1.5; P = 0.2). CONCLUSIONS: Despite the lack of statistical significance, trends towards improved survival and a lower incidence of heart failure events suggest that mitral valve repair may be beneficial in patients undergoing CF-LVAD implantation. Given the known relationship between severe MR and mortality, further study is encouraged to confirm the value of mitral valve repair in these patients.
引用
收藏
页码:620 / 623
页数:4
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