Impact of Concomitant Mitral Valve Surgery With LVAD Placement: Systematic Review and Meta‐Analysis. Issue 12 (12th August 2018)

• Record Type: Journal Article
• Authors: Choi, Jae H.; Luc, Jessica G.Y.; Moncho Escrivá, Ester; Phan, Kevin; Rizvi, Syed S. A.; Patel, Sinal; Entwistle, John W.; Morris, Rohinton J.; Massey, H. T.; Tchantchaleishvili, Vakhtang
• Is Part Of: Artificial organs. Volume 42:Issue 12(2018)
• Page Start: 1139
• Page End: 1147
• Publication Date: 2018-08-12
• Subjects: Continuous‐flow left ventricular assist devices -- Mechanical circulatory support -- Mitral regurgitation; Artificial organs -- Periodicals; 617.956
• DOI: 10.1111/aor.13295
• Languages: English
• ISSNs: 0160-564X

Abstract

Abstract : The aim of this systematic review and meta‐analysis was to evaluate the outcomes of concomitant mitral valve surgery for significant preexisting mitral regurgitation (MR) in patients undergoing continuous‐flow left ventricular assist device (CF‐LVAD) implantation. Electronic search was performed to identify all studies in the English literature examining concurrent mitral valve surgery in patients with CF‐LVAD implantation. Identified articles were systematically assessed for inclusion and exclusion criteria. Of 2319 studies identified, 8 studies were included. Among 445 patients with moderate to severe or severe MR, 113 (25.4%) patients received concurrent mitral valvular intervention during CF‐LVAD implantation. There were no significant differences in cardiopulmonary bypass time (MR Surgery 154 min vs. no MR Surgery 119 min, P = 0.64) or hospital length of stay (MR Surgery 21 days vs. no MR Surgery 18 days, P = 0.93). On follow‐up, there were no significant differences in freedom from greater than moderate MR (MR Surgery 100% vs. no MR Surgery 74%, P = 0.12) or left ventricular end‐diastolic diameter (MR Surgery: 60 mm vs. no MR Surgery 65 mm, P = 0.51). Survival was comparable at 6‐months (MR Surgery 77% vs. no MR Surgery 81%, P = 0.75), 1‐year (MR Surgery 72% vs. no MR Surgery 80%, P = 0.36), and 2‐years of follow‐up (MR Surgery 65% vs. no MR Surgery 70%, P = 0.56). The results of our systematic review and meta‐analysis of 8 studies consisting of 445 patients demonstrates that the addition of mitral valve intervention to CF‐LVAD implantation appears to be safe with comparable survival to those undergoing CF‐LVAD implantation alone. Large prospective randomized clinical trials are needed to elucidate whether concomitant mitral valve intervention during CF‐LVAD implantation in patients with severe MR is necessary.