Results After Left Ventricular Assist Device Implantation in Patients with Status Post Transcatheter Edge-to-Edge Repair

Abstract

Purpose Transcatheter edge-to-edge repair (TEER) represents a valid therapeutic option for symptomatic heart failure (HF) patients with secondary mitral regurgitation (SMR). However, based on the progression of the underlying cardiomyopathy, consecutive LVAD implantation may become necessary. The prognostic impact of TEER prior to LVAD implantation remains unknown. Methods 125 consecutive patients with advanced HF underwent LVAD implantation at our institution between 2014 and 2020. Out of 67 patients with preexisting moderate to severe SMR, 21 patients underwent TEER prior to LVAD implantation (study group) and were compared to the remaining 46 patients (control group). Clinical baseline and follow-up parameters such as re-hospitalization rates, adverse events and all-cause mortality after 12 months were retrospectively analyzed. Results Predominantly male patients (81.6%) were mainly treated with the Medtronic HVAD device (73.1%). Prevalence of cardiovascular comorbidities was similar, although patients in the study group were older (64.0 vs. 56.0 years, p=0.002) and more likely to undergo destination LVAD therapy (61.9% vs. 28.2%, p=0.009). Severity of LV dysfunction (study vs. control group: LVEF 20.0% vs. 18.0%, p=0.178; LVEDD: 67.6 mm vs. 70.5 mm p=0.316) was similar, but patients in the study group had increased transmitral pressure gradients (9.5/3.0mmHg vs. 5.0/2.0 mmHg, p=0.001) and more severe impairment of RV function (TAPSE: 12.5mm vs. 16.0mm, p=0.033). Despite a lower frequency of preoperative short-term circulatory support devices within the study group (0% vs. 67.4%, p=0.003), periprocedural outcome, including the need for temporary RVAD implantation (28.2% vs. 9.5%, p=0.119) was similar. We found no perioperative complications associated with preceded TEER. Re-hospitalization rate during the first postoperative year was increased within the study group compared to the control group (100% vs. 69.6%, p=0.004). Furthermore, 1-year survival was impaired in the study group (42.8% vs. 71.7%; p=0.023). Conclusion LVAD implantation after TEER is feasible and safe. However, 1-year outcome among LVAD recipients with prior TEER is poor. Further studies are needed, to compare TEER against early LVAD implantation in patients at advanced heart failure stages and concomitant relevant SMR. Transcatheter edge-to-edge repair (TEER) represents a valid therapeutic option for symptomatic heart failure (HF) patients with secondary mitral regurgitation (SMR). However, based on the progression of the underlying cardiomyopathy, consecutive LVAD implantation may become necessary. The prognostic impact of TEER prior to LVAD implantation remains unknown. 125 consecutive patients with advanced HF underwent LVAD implantation at our institution between 2014 and 2020. Out of 67 patients with preexisting moderate to severe SMR, 21 patients underwent TEER prior to LVAD implantation (study group) and were compared to the remaining 46 patients (control group). Clinical baseline and follow-up parameters such as re-hospitalization rates, adverse events and all-cause mortality after 12 months were retrospectively analyzed. Predominantly male patients (81.6%) were mainly treated with the Medtronic HVAD device (73.1%). Prevalence of cardiovascular comorbidities was similar, although patients in the study group were older (64.0 vs. 56.0 years, p=0.002) and more likely to undergo destination LVAD therapy (61.9% vs. 28.2%, p=0.009). Severity of LV dysfunction (study vs. control group: LVEF 20.0% vs. 18.0%, p=0.178; LVEDD: 67.6 mm vs. 70.5 mm p=0.316) was similar, but patients in the study group had increased transmitral pressure gradients (9.5/3.0mmHg vs. 5.0/2.0 mmHg, p=0.001) and more severe impairment of RV function (TAPSE: 12.5mm vs. 16.0mm, p=0.033). Despite a lower frequency of preoperative short-term circulatory support devices within the study group (0% vs. 67.4%, p=0.003), periprocedural outcome, including the need for temporary RVAD implantation (28.2% vs. 9.5%, p=0.119) was similar. We found no perioperative complications associated with preceded TEER. Re-hospitalization rate during the first postoperative year was increased within the study group compared to the control group (100% vs. 69.6%, p=0.004). Furthermore, 1-year survival was impaired in the study group (42.8% vs. 71.7%; p=0.023). LVAD implantation after TEER is feasible and safe. However, 1-year outcome among LVAD recipients with prior TEER is poor. Further studies are needed, to compare TEER against early LVAD implantation in patients at advanced heart failure stages and concomitant relevant SMR.