Impact of left ventricular assist device implantation on mitral regurgitation: An analysis from the MOMENTUM 3 trial.
J Heart Lung Transplant
; 39(6): 529-537, 2020 06.
Article
em En
| MEDLINE
| ID: mdl-32279919
ABSTRACT
BACKGROUND:
Mitral regurgitation (MR) determines pathophysiology and outcome in advanced heart failure. The impact of left ventricular assist device (LVAD) placement on clinically significant MR and its contribution to long-term outcomes has been sparsely evaluated.METHODS:
We evaluated the effect of clinically significant MR on patients implanted in the MOMENTUM 3 trial with either the HeartMate II (HMII) or the HeartMate 3 (HM3) at 2 years. Clinical significance was defined as moderate or severe grade MR determined by site-based echocardiograms.RESULTS:
Of 927 patients with LVAD implants without a prior or concomitant mitral valve procedure, 403 (43.5%) had clinically significant MR at baseline. At 1-month of support, residual MR was present in 6.2% of patients with HM3 and 14.3% of patients with HMII (relative riskâ¯=â¯0.43; 95% CI, 0.22-0.84; pâ¯=â¯0.01) with a low rate of worsening at 2 years. Residual MR at 1-month post-implant did not impact 2-year mortality for either the HM3 (hazard ratio [HR],1.41; 95% CI, 0.52-3.89; pâ¯=â¯0.50) or HMII (HR, 0.91; 95% CI, 0.37-2.26; pâ¯=â¯0.84) LVAD. The presence or absence of baseline MR did not influence mortality (HM3 HR, 0.86; 95% CI, 0.56-1.33; pâ¯=â¯0.50; HMII HR, 0.81; 95% CI, 0.54-1.22; pâ¯=â¯0.32), major adverse events or functional capacity. In multivariate analysis, severe baseline MR (pâ¯=â¯0.001), larger left ventricular dimension (pâ¯=â¯0.002), and implantation with the HMII instead of the HM3 LVAD (pâ¯=â¯0.05) were independently associated with an increased likelihood of persistent MR post-implant.CONCLUSIONS:
Hemodynamic unloading after LVAD implantation improves clinically significant MR early, sustainably, and to a greater extent with the HM3 LVAD. Neither baseline nor residual MR influence outcomes after LVAD implantation.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Coração Auxiliar
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Insuficiência Cardíaca
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Ventrículos do Coração
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Valva Mitral
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Insuficiência da Valva Mitral
Tipo de estudo:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article