Kohno Hiroki, Matsumiya Goro, Saiki Yoshikatsu, Kinugawa Koichiro, Ono Minoru
Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
JTCVS Open. 2025 Feb 13;24:96-112. doi: 10.1016/j.xjon.2025.02.002. eCollection 2025 Apr.
Mitral regurgitation may persist or progress after left ventricular assist device implantation. However, whether preexisting mitral regurgitation should be corrected at the time of implantation remains to be determined.
A retrospective, registry-based analysis was performed on 1398 continuous-flow left ventricular assist device recipients who underwent implantation between 2010 and 2022. Patients were compared for significant mitral regurgitation, defined as moderate-to-severe or greater mitral regurgitation after implantation, and major adverse events during left ventricular assist device support. Comparisons were made between patients untreated for mitral regurgitation but who had moderate or greater preexisting mitral regurgitation (n = 414) and those who had no or mild preexisting mitral regurgitation (n = 368) (cohort 1), and between patients with moderate or greater mitral regurgitation who underwent concomitant mitral valve surgery (n = 86) and those who did not (n = 414) (cohort 2).
The cumulative incidence of significant mitral regurgitation was higher in patients with untreated moderate or greater mitral regurgitation in both cohorts ( < .001 and = .025, cohorts 1 and 2, respectively). However, the cumulative incidence of all-cause mortality and readmission, and the risk of other major left ventricular assist device complications such as stroke and right heart failure were comparable between groups in both cohorts. The results were also consistent for the propensity score-matched population created in each cohort.
Significant mitral regurgitation may be prevented by concomitant surgery, but late survival and the risk of other major adverse events were not significantly improved by the procedure and were similar between patients with untreated moderate or greater mitral regurgitation and those with no or untreated mild mitral regurgitation. Our results suggest that mitral regurgitation during left ventricular assist device implantation may have only limited benefits from concomitant surgery.
左心室辅助装置植入后二尖瓣反流可能持续存在或进展。然而，植入时是否应纠正术前存在的二尖瓣反流仍有待确定。
对2010年至2022年间接受植入的1398例连续流式左心室辅助装置受者进行了一项基于注册登记的回顾性分析。比较患者植入后中重度或更严重二尖瓣反流定义的显著二尖瓣反流情况以及左心室辅助装置支持期间的主要不良事件。对术前存在中度或更严重二尖瓣反流但未接受二尖瓣反流治疗的患者（n = 414）与术前无或轻度二尖瓣反流的患者（n = 368）（队列1）进行比较，并对接受同期二尖瓣手术的中度或更严重二尖瓣反流患者（n = 86）与未接受手术的患者（n = 414）（队列2）进行比较。
两个队列中，术前存在中度或更严重二尖瓣反流且未治疗的患者中显著二尖瓣反流的累积发生率更高（队列1和队列2分别为P <.001和P = 0.025）。然而，两组患者全因死亡率和再入院的累积发生率以及其他主要左心室辅助装置并发症（如中风和右心衰竭）的风险相当。每个队列中创建的倾向评分匹配人群的结果也一致。
同期手术可预防显著二尖瓣反流，但该手术并未显著改善晚期生存率和其他主要不良事件的风险，术前存在中度或更严重二尖瓣反流的患者与无或轻度二尖瓣反流未治疗的患者相似。我们的结果表明，左心室辅助装置植入期间的二尖瓣反流同期手术可能仅带来有限益处。
