Left ventricular assist device therapy improves severe secondary mitral regurgitation without mitral valve repair

Abstract Background Severe secondary mitral regurgitation (MR) worsens prognosis in patients with medically managed heart failure (HF). In treated by left ventricular assist device (LVAD), it is unclear whether severe MR should be corrected at time of LVAD implantation. Purpose To evaluate impact therapy on and non-severe over 1 year. Methods Retrospective single centre study consecutive who underwent HeartMate (HM)2 or HM3 implantation between January 2011 March 2020. Results Of 155 patients, 20 were excluded due to exchange (n=10), valve repair (n=1), inaccessible pre-LVAD echocardiography (n=9). Based multiparametric grading, 29/135 had 106/135 (including none). more often female [10/29 (34%) vs 11/106 (10%); p=0.002] but similar age (54±12 55±9 years; p=0.624), size (27±5 27±4 kg/m2; p=1.0), equivalent renal function (53±22 55±20 ml/min/1.73m2; p=0.641) median pre-operative NT-proBNP [4076 (IQR 206–5438) 4914 2706–7518) ng/L; p=0.488]. There proportions ischaemic aetiology [16/29 (55%) 66/106 (62%); p=0.488) those receiving HM2 [11/29 (38%) 32/106 (30%)] [18/29 (62%) 74/106 (70%); p=0.575] LVAD. Echocardiography before demonstrated (LV) (LV end-diastolic volume: 133±44 118±50ml/m2; p=0.145, end-systolic 107±41 96±59ml/m2; p=0.348) LV ejection fraction (17±9 17±7%; p=1.0). significantly greater (p<0.001) proximal isovolumetric surface area (0.93±0.27 0.60±0.16cm), vena contracta (0.79±0.32 0.57±0.18cm), regurgitant volume (47±25 24±12ml), (54±15 37±13%). Follow-up (f/u) was performed a 222 days (range 356 days). Patients received cardiac transplantation f/u excluded. Relative severities were: none = 12 (46%), mild 8 (31%), moderate 5 (19%), (4%) amongst pre-LVAD, 55 (58%), 26 (27%), 13 (14%), (1%) pre-LVAD. At 1-year, after excluding all (severe n=4; n=2), rates HF hospitalisation [5/25 (20%) 16/104 (15%); all-cause mortality [2/25 (18%) 22/104 (21%); p=0.129)] similar, irrespective severity. No patient died during follow-up prior death. Conclusion improves 96% cases, resulting 1-year without These data suggest surgery not warranted. Funding Acknowledgement Type funding sources: None.