-
Should Severe Mitral Regurgitation be Addressed at LVAD
Implant?
Jonathan Haft, MDDepartment of Cardiac Surgery
University of Michigan
http://www.aats.org/aatsimis/AATS/Home/AATS/Home.aspx
-
Mitral Valve
• Anatomy of the mitral valve
-
Mitral Regurgitation
• Carpentier Classification of MR
-
Mitral Regurgitation
-
Consequences of Mitral Regurgitation
• Volume overload• Progression ventricular dilation and
dysfunction• Elevated left atrial pressure• Pulmonary
hypertension• Right ventricular dysfunction
-
Mitral Valve Repair
-
Impact of Isolated Mitral Repair on Heart Failure
• Mortality 2%• NYHA 3.9-1.8• pVO2 14.5-18.6
-
Concomitant Mitral Valve Repair
• Frequently performed during coronary bypass grafting or aortic
valve replacement
• Should it be performed during LVAD implant?• LVADs unload the
left ventricle
– Reduce left ventricular dimensions– Improve mitral geometry
and improve severity of
mitral regurgitation
-
• 100 continuous flow implants• Reduction in PA pressures
– 52 vs 36 mm Hg
-
• 361 continuous flow implants• Axial vs Centrifugal
-
2014
-
• Survival difference of additional procedure persisted when
adjusted for HMII risk score
2014
-
• 508 continuous flow implants Mechanical Circulatory Support
Research Network
-
• Patients across 4 centers• MV repair annuloplasty or
replacement
-
• Prolonged cardiopulmonary bypass time– 154 vs 109 min
• Addition of aortic cross clamp in 62%
-
2013
-
• Single center retrospective review
• Severe MR• Surgeon preference to repair• Transapical Alfieri•
CPB time 109 vs 82 min• Moderate or worse MR 24% vs
42%• Selection bias• Low pump speed operation• Echo prior to
hospital discharge
-
• Findings are based on echos obtained 1 week after LVAD
implant
-
• Residual MR associated with worse RV function, higher left and
right filling pressures
• Shorter time to rehospitalization and death
• Trend towards posterior displacement of coaptation point
-
Summary• Functional mitral regurgitation is common in heart
failure patients• LVADs reduce ventricular dimensions which
improves
postoperative mitral regurgitation• Residual severe mitral
regurgitation may be associated
with adverse events• Mitral repair using the transapical Alfieri
stitch feasible• Long term durability Alfieri stitch in LVAD
patients with
functional MR unknown• There may be echocardiographic predictors
of residual
uncorrected postoperative MR
Should Severe Mitral Regurgitation be Addressed at LVAD
Implant?Mitral ValveMitral RegurgitationMitral
RegurgitationConsequences of Mitral RegurgitationSlide Number
6Mitral Valve RepairImpact of Isolated Mitral Repair on Heart
FailureConcomitant Mitral Valve RepairSlide Number 10Slide Number
11Slide Number 12Slide Number 13Slide Number 14Slide Number 15Slide
Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number
20Slide Number 21Slide Number 22Slide Number 23Slide Number 24Slide
Number 25Slide Number 26Slide Number 27Slide Number 28Summary
