Impact of Pre-Op Mitral Regurgitation Following Left Ventricular Assist Device Implant

Abstract

Purpose Management of mitral regurgitation (MR) during left ventricular assist device (LVAD) placement is debated. This study evaluates the effect of untreated pre-op MR on outcomes following LVAD implant. Methods Adults undergoing continuous flow LVAD placement from April 2004 to May 2017 were included. Most recent pre-op transthoracic echocardiogram (TTE) was used to divide patients into a significant MR (SMR) group with moderate or greater MR, and a group without SMR. Patients underwent LVAD implant without correction of MR. Demographics, comorbidities, and hemodynamic variables were compared between cohorts. End-points included post-operative mortality , length of stay (LOS), and readmission. Resolution of SMR following VAD on 1 month post-op TTE was also studied. Results LVAD placement was performed in 270 patients, 172 (63.7%) without SMR and 98 (36.3 %) with SMR. There were no differences in patient demographics except for lower patient weight in the SMR group (86.0 kg vs 91.7kg, p=0.033). No differences were observed in co-morbidities including diabetes , hypertension, and renal disease . Pre-op ejection fraction , pulmonary artery pressure , and trans-pulmonary gradient were not different between cohorts. More patients with SMR were on milrinone pre-operatively (88.8% vs 75.6%, p=0.009). There was no difference in mortality between the 2 cohorts ( Figure). The SMR group had decreased LOS (median 19.5 vs 22 days, p=0.009), with no difference in number of days to first re-admission. SMR patients had more 1 year readmissions per patient than those without SMR (median 5 vs 4, p=0.027). Of 98 SMR patients, 91 (92.9 %) had decrease in MR to less than moderate. There were no differences in mortality or readmissions in those who had resolution in SMR and those 7 (7.1%) patients with post LVAD SMR. Conclusion Patients undergoing LVAD placement with pre-op SMR do not experience differences in mortality, and a majority experience resolution of MR after implant. Pre-op SMR may increase risk for re-admission following LVAD.