Abstract
The interactions and hemodynamic impact of transcatheter percutaneous mitral valve repair (TMR) have not yet been investigated in patients undergoing left ventricular assist device (LVAD) implantation, but hemodynamic adverse effects are feared in the combination of TMR and LVAD for altered mitral valve flow. This study investigated the hemodynamic interplay in combination of TMR and LVAD in 119 patients, and propensity score match analysis revealed no difference in both perioperative mortality and 2-year follow-up survival (p = 0.84). Nonetheless, postoperatively mean pulmonary arterial pressure, pulmonary capillary wedge pressure, and cardiac index improved, and multivariable cox regression analysis at 2 years identified preoperative total bilirubin and temporary right ventricular mechanical circulatory support as independent risk factors for all-cause mortality but not TMR. Prior TMR has no impact on mortality or cardiovascular complications in patients with LVAD. Graphical abstract
Highlights
Functional severe mitral regurgitation (FMR) is frequently observed in patients with advanced heart failure (HF)
We demonstrate safety of prior MitraClip implantation in patients undergoing left ventricular assist device (LVAD) implantation, and our results proclaim that MitraClip is not associated with worse outcome when LVAD is implanted, and we can show positive influence of LVAD regarding right heart
A total of 119 patients with FMR undergoing HeartMate 3 LVAD implantation were identified for inclusion in this study during 2016 and 2020
Summary
Functional severe mitral regurgitation (FMR) is frequently observed in patients with advanced heart failure (HF). Conflicting data are available, and retentions are expressed in HF patients after TMR that require left ventricular assist device (LVAD) implantation for HF progression [5]. It has been hypothesized that TMR may restrict mitral valve mobility, which could increase transvalvular gradients, and this could interfere or even impair LVAD inflow and LVAD function [6]. Despite this single-center and small patient cohort study, only little is known about the interplay of TMR and subsequent LVAD implantation so far, and this relationship has not yet been studied in detail. There is no data available on complication and mortality rates in patients treated with the combination of TMR and LVAD to date
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