Use of Ventricular Assist Devices in Patients with Mitral Valve Prostheses

Abstract

Use of ventricular assist devices (VADs) in patients with prosthetic valves may carry an increased risk of thromboembolism; however, clinical information is lacking. The aim of this study was to report our experience of the use of VADs in patients with prosthetic mitral valves. A retrospective analysis of 747 VAD patients from January 1995 to May 2010 was performed. Thirteen patients with a prosthetic mitral valve (average age 56 ± 10 years of age, nine mechanical valve, four biological valve) were identified. Indications for VAD implantation were as a bridge to transplant in 11 patients and destination therapy in two patients. At the time of VAD implant, no intervention to the prosthetic mitral valve was performed. Eight patients received a HeartMate I (Thoratec Corporation, Pleasanton, CA, USA), three patients received a HeartMate II (Thoratec Corporation), and two patients received a Thoratec VAD (Thoratec Corporation). Among nine mechanical valve patients, six patients were anticoagulated with warfarin, and one patient with heparin, while two patients did not receive anticoagulation due to bleeding. Ten patients were successfully transplanted at an average of 123 days post-VAD implant, one died after 48 days from multiorgan failure, and two remained on VAD support. No clinical thromboembolic events were observed. No intracardiac thrombus was detected by echocardiogram or on the pathology of the explanted hearts. Five patients had experienced a bleeding event (postoperative mediastinal bleeds, gastrointestinal bleedings, retroperitoneal hematoma, and subconjuctival bleeding). In patients with mitral valve prostheses who require VAD support, leaving the prosthesis intact does not increase the incidence of adverse events.