Validation of mitral regurgitation reversibility in patients with HeartMate 3 LVAD implantation.

Abstract

The resolution of functional mitral valve regurgitation (MR) in patients awaiting left ventricular assist device (LVAD) implantation is discussed controversially. The present study analyzed MR and echocardiographic parameters of the third-generation LVAD HeartMate 3 (HM3) over 3years. Of 135 LVAD patients (with severe MR, n=33; with none, mild, or moderate MR, n=102), data of transthoracic echocardiography were included preoperatively to LVAD implantation, up to 1month postoperatively, and at 1, 2, and 3years after LVAD implantation. Demographic data and clinical characteristics were collected. Severe MR was reduced immediately after LVAD implantation in all patients. The echocardiographic parameters left ventricular end-diastolic diameter (P<.001), right ventricular end-diastolic diameter (P<.001), tricuspid annular plane systolic excursion (P<.001), and estimated pulmonary artery pressure (P<.001) decreased after HM3 implantation independently from the grade of MR prior to implantation and remained low during the 2years follow-up period. Following LVAD implantation, right heart failure, ventricular arrhythmias, ischemic stroke as well as pump thrombosis and bleeding events were comparable between the groups. The incidences of death and cardiac death did not differ between the patient groups. Furthermore, the Kaplan-Meier analysis showed that survival was comparable between the groups (P=.073). HM3 implantation decreases preoperative severe MR immediately after LVAD implantation. This effect is long-lasting in most patients and reinforces the LVAD implantation without MR surgery. The complication rates and survival were comparable between patients with and without severe MR.