Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina.
J Heart Lung Transplant. 2022 Nov;41(11):1638-1645. doi: 10.1016/j.healun.2022.03.002. Epub 2022 Mar 5.
Left ventricular assist device (LVAD) placement frequently leads to a reduction in the severity of functional mitral regurgitation (MR). However, a significant number of LVAD supported patients have residual MR. We sought to assess the impact of residual MR in LVAD patient outcomes.
Patients in the INTERMACS registry who received a continuous flow LVAD between 2006 and 2017 without a prior mitral valve repair were included for analysis. Residual MR was defined as moderate or severe MR within the first 3 months device support. Baseline characteristics, echocardiographic and hemodynamic variables, and clinical outcomes were comparatively analyzed between those with or without residual MR.
A total of 8,364 patients were included in the study, of which 18.8% demonstrated residual MR. Younger age, female gender, and non-ischemic heart failure were predictors of residual MR, as were increased LVEDD, RV dysfunction, severe baseline MR or TR, and elevated right heart pressures. Concomitant mitral valve repair reduced the risk of residual MR. Those with residual MR demonstrated worse LV remodeling, more right ventricular dysfunction, and higher right heart pressures at almost all time points analyzed. Residual MR was associated with increased risk of right heart failure and renal failure, and a trend toward increased mortality on LVAD support.
Residual MR is associated with worse clinical outcomes on LVAD support. Strategies to minimize MR including medical and device optimization as well as valve repair should be considered in LVAD patients with residual MR.
左心室辅助装置（LVAD）的植入通常会减轻功能性二尖瓣反流（MR）的严重程度。然而，相当数量的 LVAD 支持患者仍存在 MR。我们旨在评估 LVAD 患者结局中残余 MR 的影响。
本研究纳入了 2006 年至 2017 年间接受连续血流 LVAD 治疗且无先前二尖瓣修复术的 INTERMACS 注册患者。残余 MR 定义为装置支持的前 3 个月内出现中度或重度 MR。比较分析了有或无残余 MR 的患者的基线特征、超声心动图和血流动力学变量以及临床结局。
本研究共纳入 8364 例患者，其中 18.8%存在残余 MR。年龄较小、女性、非缺血性心力衰竭是残余 MR 的预测因素，LVEDD 增大、右心功能障碍、严重基线 MR 或 TR 以及右心压力升高也是预测因素。同期二尖瓣修复可降低残余 MR 的风险。残余 MR 患者的 LV 重构更差，右心功能障碍更严重，几乎在所有分析的时间点的右心压力更高。残余 MR 与右心衰竭和肾衰竭风险增加相关，LVAD 支持时的死亡率也呈上升趋势。
残余 MR 与 LVAD 支持时的临床结局较差相关。对于存在残余 MR 的 LVAD 患者，应考虑采用包括药物和器械优化以及瓣膜修复等策略来最小化 MR。
