title: Impact of Residual Mitral Regurgitation on Right Ventricular Systolic Function After Left Ventricular Assist Device Implantation.
abstract: Significant mitral regurgitation (MR) is thought to decrease after left ventricular assist device (LVAD) implantation, and therefore repair of mitral valve is not indicated in current practice. However, residual moderate and severe MR leads to pulmonary artery pressure increase, thereby resulting in right ventricular (RV) dysfunction during follow-up. We examined the impact of residual MR on systolic function of the right ventricle by echocardiography after LVAD implantation. This study included 90 patients (mean age: 51.7 ± 10.9 years, 14.4% female) who underwent LVAD implantation (HeartMate II = 21, HeartWare = 69) in a single center between December 2010 and June 2014. Echocardiograms obtained at 3-6 months and over after implantation were analyzed retrospectively. RV systolic function was graded as normal, mild, moderate, and severely depressed. MR (≥moderate) was observed in 43 and 44% of patients at early and late period, respectively. Systolic function of the RV was severely depressed in 16 and 9% of all patients. Initial analysis (mean duration of support 174.3 ± 42.5 days) showed a statistically significant correlation between less MR and improved systolic function of RV (P = 0.01). Secondary echocardiographic analysis (following a mean duration of support of 435.1 ± 203 days) was also statistically significant for MR degree and RV systolic dysfunction (P = 0.008). Residual MR after LVAD implantation may cause deterioration of RV systolic function and cause right-sided heart failure symptoms. Repair of severe MR, in selected patients such as those with severe pulmonary hypertension and depressed RV, may be considered to improve the patient's clinical course during pump support.
authors.affiliation: Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Ertugay
authors.affiliation: Cardiology, Near East University Faculty of Medicine, Nicosia, Turkish Republic of Northern Cyprus.
authors.forename: Hatice S
authors.initials: HS
authors.lastname: Kemal
authors.affiliation: Cardiovascular Surgery, Erzincan Mengucek Gazi University, Erzincan.
authors.forename: Umit
authors.initials: U
authors.lastname: Kahraman
authors.affiliation: Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey.
authors.forename: Catagay
authors.initials: C
authors.lastname: Engin
authors.affiliation: Cardiology, Ege University Faculty of Medicine, İzmir, Turkey.
authors.forename: Sanem
authors.initials: S
authors.lastname: Nalbantgil
authors.affiliation: Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey.
authors.forename: Tahir
authors.initials: T
authors.lastname: Yagdi
authors.affiliation: Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozbaran
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000209:etiology* / Q000503:physiopathology*; D016278:Ventricular Function, Right
keywords: -Mitral regurgitation; -Right heart failure; Left ventricular assist device