Persistent Mitral Regurgitation after Left Ventricular Assist Device: A Clinical Conundrum

Purpose Persistent mitral valve regurgitation (MR) after continuous flow left ventricular assist device implantation (cfLVAD) is associated with pulmonary hypertension and right ventricular (RV) failure with variable effects on survival across published studies. The aim of this study is to determine the incidence and predictors of persistent MR at 6-month follow up after cfLVAD implantation and its impact on survival, hemodynamics, RV function and morbidity. Methods Retrospective review of all adult cfLVAD recipients from January 2012 to June 2017 at a single tertiary university hospital. Primary outcome was to compare survival between patients with no-mild and persistent moderate-severe MR at 6-months. Secondary outcomes included right heart failure (RHF, defined as right atrial pressure >=14, cardiac index Results Final analytic sample was 111 patients. The incidence of persistent moderate or severe MR was 26%. Significant predictors of persistent MR were left atrium (LA) dimension and volume. The group with persistent moderate-severe MR at 6-months had higher incidence of RHF at 6months (45% vs 25% p=0.04). There was no difference in survival at 1-year between the groups (no-mild MR 85.5%, moderate-severe MR 87.9%, Wilcoxon p-value = 0.63). There was no difference in rehospitalizations, LOS, composite of death, transplant or pump exchange at 6-months. Conclusion Persistent moderate-severe MR after cf-LVAD implantation is present in one-fourth of patients and is associated with increased incidence of RHF with no effect on 1-year survival. Increased LA size was associated with persistent moderate-severe MR at 6 months.