Alternative Approaches for the Surgical Treatment of Significant Mitral Regurgitation in Advanced Heart Failure

Abstract

Purpose Moderate-severe mitral regurgitation (MR) accompanying advanced systolic dysfunction is associated with increased risk of morbidity/mortality. Mitral valve repair/replacement (MVR) in this population remains controversial. Continuous flow LVAD (cfLVAD) may be an alternative therapy, but patient selection and outcomes data is lacking. Methods and Materials Patients with advanced heart failure receiving cfLVAD (n=95) or MVR (n=85) between 1/05 and 6/12 at our center were retrospectively reviewed. Baseline characteristics and post-operative outcomes were compared. Results MVR pts more commonly had hypertension and coronary artery disease (p Conclusions In this population cfLVAD is associated with increased 30-day morbidity but similar intermediate survival relative to MVR. Our results suggest that as these pts move along a risk continuum of worsening heart failure, cfLVAD implantation provides a survival advantage similar to high risk MVR in a less sick population. Thus, cfLVAD might be an important alternative therapy, especially as devices advance and VAD management and outcomes improve. Patient Outcomes MVR cfLVAD p-Value LOS (Days; Median[Q1,Q3]) 9.0 [7.0,12.0] 17.0 [12.0,25.0] 30-Day Mortality 6/85 (7.1%) 7/95 (7.8%) 1.0 1-Year Mortality 1485 (16.5%) 15/95 (15.8%) 1.0 Reoperation 11/85 (12.9%) 40/95 (42.1%) MI 5/85 (5.9%) 0/95 0.022 Hemorrhage 6/85 (7.1%) 31/95 (32.6%) Respiratory Failure 7/85 (8.2%) 30/95 (31.6%) 30-Day Readmit 11/85 (12.9%) 23/95 (24.2%) 0.059