Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York, USA.
J Heart Lung Transplant. 2013 Sep;32(9):897-904. doi: 10.1016/j.healun.2013.06.004. Epub 2013 Jul 11.
Previous studies have shown remarkable decrease in size of the left ventricle after left ventricular assist device (LVAD) implantation due to mechanical unloading. However, a certain number of patients continue to have significant mitral regurgitation (MR) under LVAD support. We investigated pre-operative echocardiographic features associated with persistent MR after LVAD implantation.
We retrospectively reviewed 82 consecutive patients undergoing continuous-flow LVAD implantation between 2007 and 2010. We obtained echocardiograms performed within 2 weeks before and 1 week after surgery. We investigated the pre-operative echocardiographic findings associated with significant MR post-LVAD and compared 1-year mortality after LVAD surgery between patients with and without significant MR post-LVAD.
MR was significant in 43 patients (52.4%) before LVAD surgery. Among those, 5 underwent concomitant mitral valve repair (MVr) at the time of LVAD implantation. Of the remaining 38 patients, 25 (65.8%) showed improvement of MR, whereas 13 patients (34.2%) continued to have significant MR post-LVAD. Multivariate analysis revealed that posterior displacement of the coaptation point of mitral leaflets was significantly associated with significant MR post-LVAD (hazard ratio, 1.335; 95% confidence interval, 1.035-1.721; p = 0.026) even after adjusting for the amount of pre-operative MR flow. Post-LVAD 1-year survival of patients with and without significant MR post-LVAD was not significantly different (92.3% vs 89.1%, p = 0.826).
Pre-LVAD posterior displacement of mitral leaflets may be indicative of post-operative significant MR, which would help identify echocardiographic features of functional MR refractory to simple volume reduction of the ventricle.
先前的研究表明，由于机械卸载，左心室辅助装置（LVAD）植入后左心室的体积显著减小。然而，在 LVAD 支持下，仍有一定数量的患者存在显著的二尖瓣反流（MR）。我们研究了与 LVAD 植入后持续 MR 相关的术前超声心动图特征。
我们回顾性分析了 2007 年至 2010 年间连续进行的 82 例 LVAD 植入连续患者。我们获得了手术前 2 周内和手术后 1 周内的超声心动图。我们研究了与 LVAD 后出现明显 MR 相关的术前超声心动图发现，并比较了 LVAD 手术后有和无明显 MR 的患者 1 年死亡率。
在 LVAD 手术前，43 例（52.4%）患者存在明显的 MR。其中，5 例在植入 LVAD 时同时进行了二尖瓣修复（MVr）。在其余 38 例患者中，25 例（65.8%）MR 得到改善，而 13 例（34.2%）患者在 LVAD 后仍存在明显的 MR。多变量分析显示，二尖瓣瓣叶对合点的后向移位与 LVAD 后明显 MR 显著相关（危险比，1.335；95%置信区间，1.035-1.721；p = 0.026），即使在调整了术前 MR 流量后也是如此。有和无明显 MR 的患者在 LVAD 后 1 年的生存率没有显著差异（92.3%对 89.1%，p = 0.826）。
LVAD 前二尖瓣瓣叶的后向移位可能提示术后明显的 MR，这有助于识别对心室简单容积减少反应不佳的功能性 MR 的超声心动图特征。
