Division of Cardiothoracic Surgery.
Center for Innovation and Outcomes Research, Department of Surgery.
J Heart Lung Transplant. 2020 Dec;39(12):1398-1407. doi: 10.1016/j.healun.2020.08.020. Epub 2020 Sep 3.
Functional mitral regurgitation (MR) (FMR) and atrial fibrillation (AF) are common in patients undergoing left ventricular assist device (LVAD) implantation. However, the impact of FMR and AF on clinical outcomes is uncertain. This study aimed to investigate the characteristics and prognostic significance of FMR and AF in patients with LVADs.
We retrospectively reviewed all patients who underwent LVAD implantation at our center between January 2010 and December 2017. We defined significant FMR as the ratio of MR color jet area to left atrial area of >20% and persistent or permanent AF (PeAF) as persistent or permanent AF at LVAD implantation.
A total of 380 patients were included in this analysis. Patients were divided into 6 groups: patients with no PeAF and no significant FMR (Group 1), patients with no PeAF but with significant FMR (Group 2), patients with PeAF but no significant FMR (Group 3), patients with PeAF and significant FMR (Group 4), patients with concomitant mitral valve surgery (MVS) at LVAD implantation and without PeAF (Group 5), and patients with concomitant MVS and with PeAF (Group 6). A total of 56 patients (15%) died within 2 years. Kaplan-Meier curve analysis demonstrated a 2-year survival of 81% in Group 1, 89% in Group 2, 87% in Group 3, 47% in Group 4, 87% in Group 5, and 79 % in Group 6 (log-rank test, p < 0.001). The multivariable Cox proportional-hazards model showed that classification in Group 4 was an independent predictor of mortality (hazard ratio, 4.31; 95% CI: 2.19-8.46; p < 0.001).
The coexistence of significant FMR and PeAF may represent a poor prognostic marker in patients undergoing LVAD implantation.
功能性二尖瓣反流（FMR）和心房颤动（AF）在接受左心室辅助装置（LVAD）植入的患者中很常见。然而，FMR 和 AF 对临床结局的影响尚不确定。本研究旨在探讨 FMR 和 AF 在 LVAD 患者中的特征和预后意义。
我们回顾性分析了 2010 年 1 月至 2017 年 12 月期间在我院接受 LVAD 植入的所有患者。我们将显著的 FMR 定义为 MR 彩色射流面积与左心房面积的比值>20%，并将持续性或永久性 AF（PeAF）定义为 LVAD 植入时的持续性或永久性 AF。
共有 380 例患者纳入本分析。患者被分为 6 组：无 PeAF 且无显著 FMR（组 1）、无 PeAF 但有显著 FMR（组 2）、有 PeAF 但无显著 FMR（组 3）、有 PeAF 且有显著 FMR（组 4）、在 LVAD 植入时同时进行二尖瓣手术（MVS）且无 PeAF（组 5）和同时进行 MVS 且有 PeAF（组 6）。共有 56 例患者（15%）在 2 年内死亡。Kaplan-Meier 曲线分析显示，组 1 的 2 年生存率为 81%，组 2 为 89%，组 3 为 87%，组 4 为 47%，组 5 为 87%，组 6 为 79%（对数秩检验，p<0.001）。多变量 Cox 比例风险模型显示，组 4 分类是死亡率的独立预测因素（风险比，4.31；95%可信区间：2.19-8.46；p<0.001）。
在接受 LVAD 植入的患者中，显著的 FMR 和 PeAF 共存可能代表预后不良的标志物。
