title: Mitral valve repair at the time of continuous-flow left ventricular assist device implantation confers meaningful decrement in pulmonary vascular resistance.
abstract: We hypothesized that the addition of mitral valve replacement or repair (MVR) to implantation of continuous-flow left ventricular assist device (cf-LVAD) may further decrease pulmonary vascular resistance (PVR) over Heartmate II (HMII) implantation alone. Patients undergoing MVR with concomitant HMII implantation were compared with those undergoing HMII implantation alone. Of the 57 patients undergoing cf-LVAD implantation, 21 (36.8%) underwent concomitant MVR and 36 (63.2%) underwent cf-LVAD implantation alone. Patients receiving MVR had greater decrement in PVR (59.4% vs. 35.2%, p = 0.01). Decrease in end-diastolic diameter was greater for patients receiving MVR but did not reach statistical significance (18.2 vs. 13.5 mm, p = 0.33). Duration of mechanical ventilation (121.6 vs. 181.4 hours, p = 0.45) and inotropic support (162.4 vs. 153.2 hours, p = 0.86), change in creatinine (0.19 vs. -0.26 mg/dl, p = 0.34), increase in bilirubin (2.54 vs. 1.55 mg/dl, p = 0.63), intensive care unit stay (168.0 vs. 231.5 hours, p = 0.38), and overall length of stay (32.0 vs. 42.5 days, p = 0.75) were similar. There was no difference in survival at 3 months (89.7% vs. 83.3%) and 1 year (83.7 vs. 67.3%, p = 0.34). Addition of MVR may result in greater decrement of PVR than HMII implantation alone. This may permit certain patients thought to be ineligible for transplantation to become candidates.
authors.affiliation: Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.forename: Eman
authors.initials: E
authors.lastname: Hamad
authors.forename: Lynn
authors.initials: L
authors.lastname: Wilson
authors.forename: Rachael
authors.initials: R
authors.lastname: Clark
authors.forename: Senthil N
authors.initials: SN
authors.lastname: Jayarajan
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Goldstein
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Abeel A
authors.initials: AA
authors.lastname: Mangi
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000473:pathology; D001663:Bilirubin / Q000378:metabolism; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D003404:Creatinine / Q000378:metabolism; D003971:Diastole; D005260:Female; D006333:Heart Failure / Q000601:surgery; D006352:Heart Ventricles / Q000473:pathology*; D006353:Heart-Assist Devices; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery; D012121:Respiration, Artificial; D014262:Tricuspid Valve Insufficiency / Q000601:surgery; D014655:Vascular Resistance
chemical_list: D003404:Creatinine; D001663:Bilirubin