Kawabori Masashi, Kurihara Chitaru, Conyer Ryan T, Critsinelis Andre C, Sugiura Tadahisa, Rosengart Todd, Morgan Jeffrey A
Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, TX, USA.
Department of Cardiopulmonary Transplantation and Center for Cardiac Support, Texas Heart Institute, Houston, TX, USA.
J Artif Organs. 2019 Jun;22(2):91-97. doi: 10.1007/s10047-018-1076-8. Epub 2018 Oct 25.
The effect of performing a concomitant mitral valve procedure (MVP) during continuous-flow left ventricular assist device (CF-LVAD) implantation has been reported for patients with moderate-to-severe mitral regurgitation (MR), but moderate MR is less of a clinical concern for CF-LVAD patients. There is a paucity of reports focusing on patients with severe MR. Thus, the purpose of this study was to analyze the effect of performing a concomitant MVP during CF-LVAD implantation in patients with severe preoperative MR. Between November 2003 and March 2016, 526 patients underwent primary implantation of a CF-LVAD at our center. Patients with severe MR who underwent a concomitant MVP were compared to those who did not in regard to overall survival, perioperative complications, postoperative echocardiography data, bridge-to-transplantation success, and CF-LVAD explantation. Of the 108 patients with severe MR, 26 underwent a concomitant MVP and 82 did not. These groups showed no difference in survival (p = 0.61). Additionally, the two groups had similar rates of postoperative right heart failure (p = 0.69) and readmissions (p = 0.42). The 24-month follow-up echocardiography results were also similar. Furthermore, the groups showed no difference in bridge-to-cardiac transplantation success (30.0% vs 25.0%, p = 0.80) or CF-LVAD explantation rates (0.0% vs 0.0%. p = 1.0). Our findings suggest that patients with severe MR who undergo a MVP during CF-LVAD implantation do not have superior outcomes to those who do not. However, assessments of other outcomes may show some benefits to performing concomitant MVPs.
对于中重度二尖瓣反流（MR）患者，在连续流左心室辅助装置（CF-LVAD）植入期间同期进行二尖瓣手术（MVP）的效果已有报道，但中度MR对CF-LVAD患者来说临床关注较少。针对重度MR患者的报道较少。因此，本研究的目的是分析在CF-LVAD植入期间同期进行MVP对术前重度MR患者的影响。2003年11月至2016年3月期间，526例患者在我们中心接受了CF-LVAD初次植入。将同期进行MVP的重度MR患者与未进行MVP的患者在总生存率、围手术期并发症、术后超声心动图数据、桥接移植成功率和CF-LVAD取出方面进行比较。在108例重度MR患者中，26例同期进行了MVP，82例未进行。这些组在生存率方面无差异（p = 0.61）。此外，两组术后右心衰竭发生率（p = 0.69）和再入院率（p = 0.42）相似。24个月随访的超声心动图结果也相似。此外，两组在桥接心脏移植成功率（30.0%对25.0%，p = 0.80）或CF-LVAD取出率（0.0%对0.0%，p = 1.0）方面无差异。我们的研究结果表明，在CF-LVAD植入期间进行MVP的重度MR患者，其结局并不优于未进行MVP者。然而，对其他结局的评估可能显示同期进行MVP有一些益处。
