title: Pre-operative echocardiographic features associated with persistent mitral regurgitation after left ventricular assist device implantation.
abstract: BACKGROUND
  Previous studies have shown remarkable decrease in size of the left ventricle after left ventricular assist device (LVAD) implantation due to mechanical unloading. However, a certain number of patients continue to have significant mitral regurgitation (MR) under LVAD support. We investigated pre-operative echocardiographic features associated with persistent MR after LVAD implantation.
  
  
  METHODS
  We retrospectively reviewed 82 consecutive patients undergoing continuous-flow LVAD implantation between 2007 and 2010. We obtained echocardiograms performed within 2 weeks before and 1 week after surgery. We investigated the pre-operative echocardiographic findings associated with significant MR post-LVAD and compared 1-year mortality after LVAD surgery between patients with and without significant MR post-LVAD.
  
  
  RESULTS
  MR was significant in 43 patients (52.4%) before LVAD surgery. Among those, 5 underwent concomitant mitral valve repair (MVr) at the time of LVAD implantation. Of the remaining 38 patients, 25 (65.8%) showed improvement of MR, whereas 13 patients (34.2%) continued to have significant MR post-LVAD. Multivariate analysis revealed that posterior displacement of the coaptation point of mitral leaflets was significantly associated with significant MR post-LVAD (hazard ratio, 1.335; 95% confidence interval, 1.035-1.721; p = 0.026) even after adjusting for the amount of pre-operative MR flow. Post-LVAD 1-year survival of patients with and without significant MR post-LVAD was not significantly different (92.3% vs 89.1%, p = 0.826).
  
  
  CONCLUSIONS
  Pre-LVAD posterior displacement of mitral leaflets may be indicative of post-operative significant MR, which would help identify echocardiographic features of functional MR refractory to simple volume reduction of the ventricle.
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kitada
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.forename: Sunu S
authors.initials: SS
authors.lastname: Thomas
authors.forename: Suzanne D
authors.initials: SD
authors.lastname: Conwell
authors.forename: Cesare
authors.initials: C
authors.lastname: Russo
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.forename: Maryjane
authors.initials: M
authors.lastname: Farr
authors.forename: P Christian
authors.initials: PC
authors.lastname: Schulze
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D015999:Multivariate Analysis; D011300:Preoperative Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000628:therapy
keywords: echocardiography; heart failure; mitral regurgitation; ventricular assist device