Influence of postimplant mitral regurgitation on durable left ventricular assist device outcomes

The association of significant postimplant mitral regurgitation (PI-MR) with left ventricular assist device (LVAD) outcomes remains controversial. We investigated PI-MR in the setting of contemporary LVAD therapy.

The Society of Thoracic Surgeons Intermacs National Database was queried and identified 2858 patients with a fully magnetically levitated centrifugal flow LVAD implanted from 2017 to 2021 who met study inclusion and exclusion criteria. Kaplan-Meir methodology and Cox proportional hazard modeling were used to evaluate the long-term influence of PI-MR on post-LVAD outcomes conditional on surviving 3 months post-LVAD implant. Significant PI-MR was defined as moderate-to-severe MR at the 1- or 3-month follow-up echocardiogram.

There were 340 patients with significant PI-MR and 2518 without PI-MR following LVAD implant. Those with significant PI-MR were younger (age 53.2 vs 57.7 years; P < .001), more likely to have a nonischemic cardiomyopathy etiology of heart failure (66.5% vs 51.5%; P < .0001), preoperative moderate-to-severe tricuspid regurgitation (51.5% vs 37.6%; P < .001), and concomitant tricuspid valve replacement/repair (17.1% vs 9.4%; < .001). Of those with preoperative significant MR, 17% (n = 274) had significant PI-MR. Significant PI-MR was associated with worse 2-year survival (88.3% vs 79.5%; P = .008), risk for readmission (hazard ratio, 1.19; P = .032) and subsequent renal failure (hazard ratio, 1.84; P = .014).

Significant PI-MR following contemporary LVAD implant adversely influences long-term survival and readmission. Strategies to prevent or intervene upon significant PI-MR require further investigation.