Lvad Implantation and Concomitant Valvular Surgery: Analysis of In-hospital Outcomes

Abstract

Background Valvular heart disease is common among Left Ventricular Assist Device (LVAD) recipients. However, its management at the time of LVAD implantation remains controversial. Methods Patients who underwent LVAD implantation and concomitant aortic (AVR), mitral (MVR) or tricuspid valve (TVR) repair or replacement between 2010 and 2017 were identified using the national inpatient sample (NIS). Endpoints were in-hospital outcomes, length of stay and cost. Procedure-related complications were identified via ICD-9 and ICD-10 coding and analysis was performed via mixed effect models. Results A total of 25,171 weighted adults underwent LVAD implantation without valvular surgery, 1,329 had isolated TVR, 1,021 AVR, 377 MVR and 615 had combined valvular surgery (411 had TVR+AVR, 115 TVR+MVR, 62 AVR+MVR, 25 AVR+MVR+TVR). During the study period, rates of AVR decreased and combined valvular surgeries increased. Patients who underwent TVR or combined valvular surgery had overall higher burden of comorbidities than LVAD recipients with or without other valvular procedures. Post-operative bleeding was higher with AVR whereas acute kidney injury requiring dialysis was higher with TVR or combined valvular surgery. In-hospital mortality was higher with AVR, MVR or combined surgery without differences in the rates of stroke. Length of stay did not differ significantly among groups but cost of hospitalization and non-routine discharge rates were higher for cases of TVR and combined surgery. Conclusion Approximately one in nine LVAD recipients underwent concomitant valvular surgery and TVR was the most frequently performed procedure. In-hospital mortality and cost were lower among those who did not undergo valvular surgery.