Impact of Residual Valve Disease on Survival After Implantation of Left Ventricular Assist Devices.

BACKGROUND: This retrospective single-institutional study investigated the effect of significant valvular regurgitation after left ventricular assist device (LVAD) implantation and the role of concomitant valve surgery during LVAD surgery.

METHODS: All patients receiving an LVAD (HeartMate II; Abbott, Abbott Park, IL) during 2008 and 2015 were enrolled. The cohort was divided into two groups based on the valve status at the end of the operation: patients without significant valvular regurgitation (no-VR) and those with significant valvular regurgitation (residual-VR).

RESULTS: An LVAD was implanted in 270 patients. Of these, 233 had significant preoperative valve disease(s), and 180 (66.6%) received concomitant valve interventions (35 aortic, 90 mitral, 138 tricuspid). At the completion of the LVAD operation, 204 had no-VR and 66 had residual-VR. Short-term outcomes were similar in two groups, except for longer cardiopulmonary bypass time in the no-VR group (149 minutes) than in the residual-VR group (132 minutes, p = 0.038). During follow-up, mean pulmonary artery pressure (24 mm Hg in no-VR vs 27 mm Hg in residual-VR; p = 0.018) and pulmonary vascular resistance (1.8 Wood units in no-VR vs 2.7 Wood units in residual-VR, p = 0.008) significantly improved in no-VR group compared with the residual-VR group. Survival and heart failure admission-free rates at 1 year were significantly superior in the no-VR group compared with the residual-VR group (1-year survival: 72% ± 3% No-VR vs 55% ± 6% residual-VR; log-rank p = 0.026; admission-free survival: 91% ± 2% no-VR vs 74% ± 7% residual-VR; log-rank p = 0.026). Concomitant valve intervention was not an independent predictor of in-hospital death and morbidity.

CONCLUSIONS: Absence of valvular lesion after LVAD implantation was associated with improved midterm hemodynamics and survival in the current study. Aggressive surgical intervention for significant valve disease(s) at the time of LVAD implant may be beneficial to selected patients.