Persistent mitral regurgitation after left ventricular assist device: a clinical conundrum

Area of Science:

• Cardiology
• Medical Devices
• Heart Failure Management

Background:

• Persistent mitral regurgitation (MR) post-continuous flow left ventricular assist device (cfLVAD) implantation is linked to pulmonary hypertension and right ventricular failure.
• The impact of persistent MR on survival and hemodynamics after cfLVAD is variable across studies.

Purpose of the Study:

• To determine the incidence and predictors of persistent MR at 6 months after cfLVAD implantation.
• To assess the impact of persistent MR on survival, hemodynamics, right ventricular function, and morbidity.

Main Methods:

• Retrospective review of adult cfLVAD recipients (January 2012-June 2017) with follow-up until April 2019.
• Comparison of survival between patients with no-to-mild MR versus persistent moderate-to-severe MR at 6 months.
• Analysis of secondary outcomes including right heart failure, length of stay, re-hospitalizations, and composite endpoints.

Main Results:

• The incidence of persistent moderate or severe MR at 6 months was 26%.
• Left atrium dimension and volume were significant predictors of persistent MR.
• Patients with persistent moderate-to-severe MR had a higher incidence of right heart failure at 6 months (45% vs. 25%, P=0.04).
• No significant difference in 1-year survival, re-hospitalizations, or length of stay was observed between groups.

Conclusions:

• Persistent moderate-to-severe MR occurs in approximately one-fourth of cfLVAD patients.
• Persistent MR is associated with increased right heart failure and elevated pulmonary pressures but does not affect 1-year survival.
• Increased left atrium size is a predictor of persistent moderate-to-severe MR at 6 months post-cfLVAD.