BACKGROUND: We investigated the clinical outcomes after cardiac valvular surgery procedures concomitant (CCPs) with left ventricular assist device (LVAD) implantation compared to propensity score (PS) matched controls using the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) data. METHODS: Between 2006 and 2018, 2760 continuous-flow LVAD patients were identified. Of these, 533 underwent a CCP during the LVAD implant. RESULTS: Cardiopulmonary bypass time (p < 0.001) and time for implant (p < 0.001) were both significantly longer in the LVAD+CCP group. Hospital mortality was comparable between the two groups from the unmatched population (15.7% vs. 14.1%, p = 0.073). Similarly, short-to-mid-term survival was similar in both groups, with 1-year, 3-year, and 5-year survival rates of 67.9%, 48.2%, and 27.7% versus 66.4%, 46.1%, and 26%, respectively (log-rank, p = 0.25). The results were similar in the PS-matched population. Hospital mortality was comparable between the two groups (18.9% vs. 17.4%, p = 0.074). The short-to-mid-term Kaplan-Meier survival analysis was similar for both groups, with 1-year, 3-year, and 5-year survival rates of 63.4%, 49.2%, and 24.7% versus 66.5%, 46%, and 25.1%, respectively (log-rank, p = 0.81). In the unmatched population, LVAD+CCP patients had longer intensive care unit (ICU) stays (p < 0.0001), longer mechanical ventilation time (p = 0.001), a higher rate of temporary right ventricular assist device (RVAD) support (p = 0.033), and a higher rate of renal replacement therapy (n = 35, 6.6% vs. n = 89, 4.0%, p = 0.014). In the PS-matched population, the LVAD+CCP patients had longer ICU stays (p = 0.019) and longer mechanical ventilation time (p = 0.002). CONCLUSIONS: The effect of additive valvular procedures (CCPs) does not seem to affect short-term survival, significantly, based on our registry data analysis. However, the decision to perform CCPs should be balanced with the projected type of surgery and preoperative characteristics. LVAD+CCP patients remain a delicate population and adverse device-related events should be strictly monitored and managed.

Division of Cardiac Surgery IRCCS Azienda Ospedaliero Universitaria di Bologna S Orsola Hospital Bologna Italy

EACTS EUROMACS Windsor UK

German Heart Institute Berlin Berlin Germany

Heart and Diabetes Center North Rhine Westphalia Ruhr Un Bad Oeynhausen Germany

Institute for Clinical and Experimental Medicine Prague Czech Republic

Katholieke Universiteit Leuven Leuven Belgium

Medical University of Vienna Vienna Austria

National Research Cardiac Surgery Center Astana Kazakhstan Kazakhstan

Zobrazit více v PubMed

Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson LW, Blume ED, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015;34:1495-504.

Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA, et al. International Society for Heart and Lung Transplantation: The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013;32:157-87.

Potapov EV, Antonides C, Crespo-Leiro MG, Combes A, Färber G, Hannan MM, et al. 2019 EACTS Expert Consensus on long-term mechanical circulatory support. Eur J Cardiothorac Surg. 2019;56(2):230-70.

John R, Naka Y, Park SJ, Sai-Sudhakar C, Salerno C, Sundareswaran KS, et al. Impact of concurrent surgical valve procedures in patients receiving continuous-flow devices. J Thorac Cardiovasc Surg. 2014;147:581-9.

Morgan JA, Tsiouris A, Nemeh HW, Hodari A, Karam J, Brewer RJ, et al. Impact of concomitant cardiac procedures performed during implantation of long-term left ventricular assist devices. J Heart Lung Transplant. 2013;32:1255-61.

Sugiura T, Kurihara C, Kawabori M, Critsinelis AC, Wang S, Civitello AB, et al. Concomitant valve procedures in patients undergoing continuous-flow left ventricular assist device implantation: a single-center experience. J Thorac Cardiovasc Surg. 2019;158:1083-9.

Milano C, Pagani FD, Slaughter MS, Pham DT, Hathaway DR, Jacoski MV, et al. ADVANCE Investigators. Clinical outcomes after implantation of a centrifugal flow left ventricular assist device and concurrent cardiac valve procedures. Circulation. 2014;130(11 suppl 1):S3-11.

Maltais S, Haglund NA, Davis ME, Aaronson KD, Pagani FD, Dunlay SM, et al. Outcomes after concomitant procedures with left ventricular assist device implantation: implications by device type and indication. ASAIO J. 2016;62:403-9.

Wang TS, Hernandez AF, Felker GM, Milano CA, Rogers JG, Patel CB. Valvular heart disease in patients supported with left ventricular assist devices. Circ Heart Fail. 2014;7:215-22.

Topilsky Y, Hasin T, Oh JK, Borgeson DD, Boilson BA, Schirger JA, et al. Echocardiographic variables after left ventricular assist device implantation associated with adverse outcome. Circ Cardiovasc Imaging. 2011;4:648-61.

Robertson JO, Naftel DC, Myers SL, Prasad S, Mertz GD, Itoh A, et al. Concomitant aortic valve procedures in patients undergoing implantation of continuous flow left ventricular assist devices: an INTERMACS database analysis. J Heart Lung Transplant. 2015;34:797-805.

McKellar SH, Deo S, Daly RC, Durham LA III, Joyce LD, Stulak JM, et al. Durability of central aortic valve closure in patients with continuous flow left ventricular assist devices. J Thorac Cardiovasc Surg. 147:344-8.

Fukuhara S, Takeda K, Chiuzan C, Han J, Polanco AR, Yuzefpolskaya M, et al. Concomitant aortic valve repair with continuous-flow left ventricular assist devices: results and implications. J Thorac Cardiovasc Surg. 2016;151:201-10.

Dranishnikov N, Stepanenko A, Potapov EV, Dandel M, Siniawski H, Mladenow A, et al. Simultaneous aortic valve replacement in left ventricular assist device recipients: single-center experience. Int J Artif Organs. 2012;35(7):489-94.

Fukuhara S, Takeda K, Chiuzan C, Han J, Kurlansky PA, Takayama H, et al. Concomitant mitral repair and continuous-flow left ventricular assist devices: is it warranted? J Thorac Cardiovasc Surg. 2017;154:1303-12.

Tanaka A, Onsager D, Song T, Cozadd D, Kim G, Sarswat N, et al. Surgically corrected mitral regurgitation during left ventricular assist device implantation is associated with low recurrence rate and improved midterm survival. Ann Thorac Surg. 2017;103:725-33.

Taghavi S, Hamad E, Wilson L, Clark R, Jayarajan SN, Uriel N, et al. Mitral valve repair at the time of continuous-flow left ventricular assist device implantation confers meaningful decrement in pulmonary vascular resistance. ASAIO J. 2013;59:469-73.

Kawabori M, Kurihara C, Conyer RT, Critsinelis AC, Sugiura T, Rosengart T, et al. Effect of concomitant mitral valve procedures for severe mitral regurgitation during left ventricular assist device implantation. J Artif Organs. 2019;22:91-7.

Sandoval E, Singh SK, Carillo JA, Baldwin AC, Ono M, Anand J, et al. Impact of concomitant mitral valve repair for severe mitral regurgitation at the time of continuous-flow left ventricular assist device insertion. Interact CardioVasc Thorac Surg. 2017;25:620-3.

Stulak JM, Tchantchaleishvili V, Haglund NA, Davis ME, Schirger JA, Cowger JA, et al. Uncorrected pre-operative mitral valve regurgitation is not associated with adverse outcomes after continuous-flow left ventricular assist device implantation. J Heart Lung Transplant. 2015;34:718-23.

Morgan JA, Brewer RJ, Nemeh HW, Murthy R, Williams CT, Lanfear DE, et al. Left ventricular reverse remodelling with a continuous flow left ventricular assist device measured by left ventricular end-diastolic dimensions and severity of mitral regurgitation. ASAIO J. 2012;58:574-7.

Robertson JO, Naftel DC, Myers SL, Tedford RJ, Joseph SM, Kirklin JK, et al. Concomitant mitral valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: an INTERMACS database analysis. J Heart Lung Transplant. 2018;37:79-88.

Piacentino V, Williams ML, Depp T, Garcia-Huerta K, Blue L, Lodge AJ, et al. Impact of tricuspid valve regurgitation in patients treated with implantable left ventricular assist devices. Ann Thorac Surg. 2011;91:1342-6.

Saeed D, Kidambi T, Shalli S, Lapin B, Malaisrie SC, Lee R, et al. Tricuspid valve repair with left ventricular assist device implantation: is it warranted? J Heart Lung Transplant. 2011;30:530-5.

Krishan K, Nair A, Pinney S, Adams DH, Anyanwu AC. Liberal use of tricuspid-valve annuloplasty during left-ventricular assist device implantation. Eur J Cardiothorac Surg. 2012;41:213-7.

Imamura T, Narang N, Nnanabu J, Rodgers D, Raikhelkar J, Kalantari S, et al. Haemodynamics of concomitant tricuspid valve procedures at LVAD implantation. J Card Surg. 2019;34:1511-8.

Maltais S, Topilsky Y, Tchantchaleishvili V, McKellar SH, Durham LA, Joyce LD, et al. Surgical treatment of tricuspid valve insufficiency promotes early reverse remodelling in patients with axial-flow left ventricular assist devices. J Thorac Cardiovasc Surg. 2012;143:1370-6.

Veen KV, Caliskan K, de By TMMH, Mokhles MM, Soliman OI, Mohacsi P, et al. Outcomes after tricuspid valve surgery concomitant with left ventricular assist device implantation in the EUROMACS registry: a propensity score matched analysis. Eur J Cardiothorac Surg. 2019;56(6):1081-9.

Robertson JO, Grau-Sepulveda MV, Okada S, O’Brien SM, Brennan JM, Shah AS, et al. Concomitant tricuspid valve surgery during implantation of continuous-flow left ventricular assist devices: a Society of Thoracic Surgeons database analysis. J Heart Lung Transplant. 2014;33:609-17.

Musci M, Loforte A, Potapov EV, Krabatsch T, Weng Y, Pasic M, et al. Body mass index and outcome after ventricular assist device placement. Ann Thorac Surg. 2008;86(4):1236-42.

Yoon SH, Schmidt T, Bleiziffer S, Schofer N, Fiorina C, Munoz-Garcia AJ, et al. Transcatheter aortic valve replacement in pure native aortic valve regurgitation. J Am Coll Cardiol. 2017;70(22):2752-63.

D'Ancona G, Pasic M, Buz S, Drews T, Dreysse S, Hetzer R, et al. TAVI for pure aortic valve insufficiency in a patient with a left ventricular assist device. Ann Thorac Surg. 2012;93(4):e89-91.

Impact of concomitant aortic valve replacement in patients with mild-to-moderate aortic valve regurgitation undergoing left ventricular assist device implantation: EUROMACS analysis