Abstract
Introduction: This is a retrospective single-institutional study to investigate safety and efficacy of concomitant valve procedures in patients undergoing left ventricular assist device (LVAD) implantation. Methods: From July 2008 to December 2014, 254 patients underwent LVAD implantation. 165 patients had concomitant valve intervention (aortic valve [A], N=3; mitral valve [M], N=78; tricuspid valve [T], N=131; multiple valve intervention, N=67, A+M=3, A+T=11, M+T=44, A+M+T=9). Patients were divided into two groups: Group D, with residual diseased valve, N=97; and Group C, with no-diseased valve, N=157) (see details in figure) and short-/mid-term outcomes were compared. Results: Intraoperative and postoperative outcomes did not differ in two groups except for significantly more concomitant valve procedures (Group D=54 [56%], Group C=111 [70%], P<.0001) and longer cardio-pulmonary bypass time (Group D=125 min vs Group C=148min, P = 0.003) in Group C compared to Group D. There was no statistically significant difference in two groups in In-hospital mortality with a tendency to be favorable to Group C (Group D=19.6% vs Group C=11.6%, P=0.09). Concomitant valve intervention did not increase in-hospital mortality (LVAD+valve=15.7%, isolated LVAD=14.1%, P=0.73). During mid-term follow up, mean pulmonary artery pressure (mmHg)(Group D=27, Group N=22, P=0.012) and wedge pressure (Group D=15, Group C=12,P=0.038) were significantly lower in Group C compared to Group D. Post-LVAD implant survival and freedom from heart failure readmission rate at 1 year were significantly higher in Group C compared to Group D (survival, Group D=59 ± 5%, Group C=72 ± 3%, P=0.035; admission, Group D=79 ± 5%, Group C=88±3%, P=0.034) Conclusions: Concomitant valve procedure during LVAD implantation did not increase operative morbidity and mortality. Aggressive valve intervention during LVAD implantation may contribute to improved mid-term hemodynamics and survival.
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