Outcomes of MitraClip and Surgical Mitral Valve Repair in Patients With Left Ventricular Assist Device

Abstract

Innovations in left ventricular assist devices (LVADs) have revolutionized the treatment of advanced heart failure. 1 Kirklin JK Naftel DC Pagani FD Kormos RL Stevenson LW Blume ED Miller MA Baldwin JT Young JB. Sixth INTERMACS annual report: a 10,000-patient database. J Heart Lung Transplant. 2014; 33: 555-564 Abstract Full Text Full Text PDF PubMed Scopus (674) Google Scholar ,2 Rose EA Gelijns AC Moskowitz AJ Heitjan DF Stevenson LW Dembitsky W Long JW Ascheim DD Tierney AR Levitan RG Watson JT Meier P Ronan NS Shapiro PA Lazar RM Miller LW Gupta L Frazier OH Desvigne-Nickens P Oz MC Poirier VL Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) Study Group. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001; 345: 1435-1443 Crossref PubMed Scopus (3289) Google Scholar However, accurate outcome prognostication is limited in the context of concomitant cardiac lesions, particularly lesions of the mitral valve in this unique patient population. Historically, severe mitral regurgitation (MR) has not been treated surgically during LVAD implantation because of its association with early mortality and morbidity. 3 Firstenberg MS Sai-Sudhakar CB Anyanwu A. Valvular disease in patients requiring long-term left ventricular assist devices: pathophysiology and therapeutic options. Expert Rev Cardiovasc Ther. 2012; 10: 205-213 Crossref Scopus (4) Google Scholar ,4 Pal JD Klodell CT John R Pagani FD Rogers JG Farrar DJ Milano CA HeartMate II Clinical Investigators. Low operative mortality with implantation of a continuous-flow left ventricular assist device and impact of concurrent cardiac procedures. Circulation. 2009; 120: S215-S219 Crossref PubMed Scopus (80) Google Scholar In the era of pulsatile devices, the unloading of the left ventricle resulted in little residual volume during systole and hence little volume to regurgitate. 5 Pawale A Itagaki S Parikh A Pinney SP Adams DH Anyanwu AC. Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation. J Thorac Cardiovasc Surg. 2019; 157 (e1): 1841-1848 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar However, with the advent of continuous-flow devices, the constant severe MR after LVAD implantation eventually results in right-sided heart failure and persistently elevated pulmonary arterial pressures. 6 Ammirati E Musca F Cannata A Garascia A Verde A Pacher V Moreo A Oliva F Martinelli L Frigerio M. Limited changes in severe functional mitral regurgitation and pulmonary hypertension after left ventricular assist device implantation: a clue to consider concurrent mitral correction?. Int J Cardiol. 2013; 167: e35-e37 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ,7 Taghavi S Hamad E Wilson L Clark R Jayarajan SN Uriel N Goldstein DJ Takayama H Naka Y Mangi AA. Mitral valve repair at the time of continuous-flow left ventricular assist device implantation confers meaningful decrement in pulmonary vascular resistance. ASAIO J. 2013; 59: 469-473 Crossref PubMed Scopus (44) Google Scholar Institutional and individual differences exist regarding the treatment of MR in patients with LVADs because current guidelines are ambiguous. Our study aims to investigate outcomes of patients with LVADs who underwent MitraClip (Abbott, Abbott Park, Illinois) implantation versus surgical mitral valve repair (MVR).