Medical Sciences Division, University of Oxford, Oxford, UK.
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.
Artif Organs. 2023 Aug;47(8):1250-1261. doi: 10.1111/aor.14549. Epub 2023 Apr 22.
Left ventricular assist devices (LVADs) represent an important therapeutic option for patients progressing to end-stage heart failure. LVAD has previously been shown to have a promising role in improving mitral regurgitation (MR). Nevertheless, the prognostic value of preoperative uncorrected MR in this population remains unclear.
A systematic database search with meta-analysis was conducted of comparative original articles of patients with preoperative mild MR (Grade 0-I) versus moderate-severe MR (Grade II-III) undergoing LVAD implantation, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to June 2022. Primary outcomes were overall and operative mortality. Secondary outcomes were neurological dysfunction, gastrointestinal bleeding, right heart failure, LVAD thrombosis, and driveline infection.
Our search yielded 2228 relevant studies. A total of 19 studies met the inclusion criteria with a total of 11 873 patients. LVAD caused a statistically significant decrease of 35.9% in the number of patients with moderate-severe MR (grade II-III) postoperatively. No significant difference was observed in terms of overall mortality, operative mortality, GI bleeding, LVAD thrombosis, and driveline infection rates between mild and moderate-severe MR. An increased rate of right heart failure was seen among patients with moderate-severe MR, while lower rates of neurological events were also observed.
LVAD improves the haemodynamics of the left ventricle, to promote resolution of MR. Nevertheless, the severity of preoperative mitral regurgitation in patients undergoing LVAD deployment does not seem to affect mortality.
左心室辅助装置 (LVAD) 代表了一种治疗终末期心力衰竭患者的重要选择。LVAD 此前已被证明在改善二尖瓣反流 (MR) 方面具有广阔前景。然而，在这一人群中，术前未经矫正的 MR 的预后价值仍不清楚。
对 EMBASE、MEDLINE、Cochrane 数据库和 Google Scholar 从创建到 2022 年 6 月进行了系统的数据库搜索和荟萃分析，比较了接受 LVAD 植入术的术前轻度 MR（0-1 级）和中重度 MR（2-3 级）患者的原始比较文章。主要结局为总死亡率和手术死亡率。次要结局为神经功能障碍、胃肠道出血、右心衰竭、LVAD 血栓形成和导线感染。
我们的搜索产生了 2228 项相关研究。共有 19 项研究符合纳入标准，共纳入 11873 例患者。LVAD 术后中重度 MR（2-3 级）患者数量显著减少 35.9%。轻度和中重度 MR 患者的总死亡率、手术死亡率、胃肠道出血、LVAD 血栓形成和导线感染率无显著差异。中重度 MR 患者的右心衰竭发生率增加，而神经事件发生率较低。
LVAD 改善了左心室的血液动力学，促进了 MR 的缓解。然而，接受 LVAD 植入的患者术前二尖瓣反流的严重程度似乎并不影响死亡率。
