Concomitant valve procedures in patients undergoing continuous-flow left ventricular assist device implantation: A single-center experience

Tadahisa Sugiura, Chitaru Kurihara, Masashi Kawabori, Andre C. Critsinelis, Suwei Wang, Andrew B. Civitello, Todd K. Rosengart, O. H. Frazier, Jeffrey A. Morgan

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Long-term support with continuous-flow left ventricular assist devices (CF-LVADs) has improved the outcomes of patients with end-stage heart failure. However, valve disease management in patients who undergo CF-LVAD implantation remains controversial. The aim of this study was to assess our single-center experience with patients who underwent a concomitant valve procedure during implantation of a CF-LVAD. Methods: From November 2003 through March 2016, 526 patients underwent primary CF-LVAD implantation with a HeartMate II (St Jude Inc, St Paul, Minn; n = 403) or HeartWare (Medtronic, Minneapolis, Minn; n = 123) device at our center. Of those, 91 underwent a concomitant valve procedure during implantation (CF-LVAD+valve procedure group), whereas 435 did not (CF-LVAD–only group). We compared preoperative characteristics and short-term and mid-term survival rates between these groups. Results: The concomitant valve procedures performed included 13 tricuspid valve repairs, 19 aortic valve repairs or replacements, 30 mitral valve repairs or replacements, and 29 double valve repairs or replacements. Survival rates at 1 month, 6 months, 12 months, and 24 months were 90.3%, 81.4%, 74.9%, and 67.4%, respectively, for the CF-LVAD–only group and 89.0%, 75.8%, 70.3%, and 65.9%, respectively, for the CF-LVAD+valve procedure group (P = .55). The results of Cox regression multivariable modeling showed that performing a concomitant valve procedure was not an independent predictor of mortality (hazard ratio, 1.29; 95% confidence interval, 0.96-1.74; P = .08). Conclusions: In our experience, performing a concomitant valve procedure during CF-LVAD implantation was not associated with an increased mortality rate. The decision to perform a concomitant valve procedure should be made primarily on the basis of clinical indications for the procedure.

Original languageEnglish (US)
Pages (from-to)1083-1089.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume158
Issue number4
DOIs
StatePublished - Oct 2019
Externally publishedYes

Fingerprint

Heart-Assist Devices
Survival Rate
Tricuspid Valve
Mortality
Disease Management
Aortic Valve
Mitral Valve
Heart Failure
Confidence Intervals
Equipment and Supplies

Keywords

  • concomitant valve procedures
  • heart failure
  • left ventricular assist device
  • valve disease

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Concomitant valve procedures in patients undergoing continuous-flow left ventricular assist device implantation : A single-center experience. / Sugiura, Tadahisa; Kurihara, Chitaru; Kawabori, Masashi; Critsinelis, Andre C.; Wang, Suwei; Civitello, Andrew B.; Rosengart, Todd K.; Frazier, O. H.; Morgan, Jeffrey A.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 158, No. 4, 10.2019, p. 1083-1089.e1.

Research output: Contribution to journalArticle

Sugiura, Tadahisa ; Kurihara, Chitaru ; Kawabori, Masashi ; Critsinelis, Andre C. ; Wang, Suwei ; Civitello, Andrew B. ; Rosengart, Todd K. ; Frazier, O. H. ; Morgan, Jeffrey A. / Concomitant valve procedures in patients undergoing continuous-flow left ventricular assist device implantation : A single-center experience. In: Journal of Thoracic and Cardiovascular Surgery. 2019 ; Vol. 158, No. 4. pp. 1083-1089.e1.
@article{5e0dcd312b5b4af7af871caaadcbed16,
title = "Concomitant valve procedures in patients undergoing continuous-flow left ventricular assist device implantation: A single-center experience",
abstract = "Objective: Long-term support with continuous-flow left ventricular assist devices (CF-LVADs) has improved the outcomes of patients with end-stage heart failure. However, valve disease management in patients who undergo CF-LVAD implantation remains controversial. The aim of this study was to assess our single-center experience with patients who underwent a concomitant valve procedure during implantation of a CF-LVAD. Methods: From November 2003 through March 2016, 526 patients underwent primary CF-LVAD implantation with a HeartMate II (St Jude Inc, St Paul, Minn; n = 403) or HeartWare (Medtronic, Minneapolis, Minn; n = 123) device at our center. Of those, 91 underwent a concomitant valve procedure during implantation (CF-LVAD+valve procedure group), whereas 435 did not (CF-LVAD–only group). We compared preoperative characteristics and short-term and mid-term survival rates between these groups. Results: The concomitant valve procedures performed included 13 tricuspid valve repairs, 19 aortic valve repairs or replacements, 30 mitral valve repairs or replacements, and 29 double valve repairs or replacements. Survival rates at 1 month, 6 months, 12 months, and 24 months were 90.3{\%}, 81.4{\%}, 74.9{\%}, and 67.4{\%}, respectively, for the CF-LVAD–only group and 89.0{\%}, 75.8{\%}, 70.3{\%}, and 65.9{\%}, respectively, for the CF-LVAD+valve procedure group (P = .55). The results of Cox regression multivariable modeling showed that performing a concomitant valve procedure was not an independent predictor of mortality (hazard ratio, 1.29; 95{\%} confidence interval, 0.96-1.74; P = .08). Conclusions: In our experience, performing a concomitant valve procedure during CF-LVAD implantation was not associated with an increased mortality rate. The decision to perform a concomitant valve procedure should be made primarily on the basis of clinical indications for the procedure.",
keywords = "concomitant valve procedures, heart failure, left ventricular assist device, valve disease",
author = "Tadahisa Sugiura and Chitaru Kurihara and Masashi Kawabori and Critsinelis, {Andre C.} and Suwei Wang and Civitello, {Andrew B.} and Rosengart, {Todd K.} and Frazier, {O. H.} and Morgan, {Jeffrey A.}",
year = "2019",
month = "10",
doi = "10.1016/j.jtcvs.2019.02.040",
language = "English (US)",
volume = "158",
pages = "1083--1089.e1",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Concomitant valve procedures in patients undergoing continuous-flow left ventricular assist device implantation

T2 - A single-center experience

AU - Sugiura, Tadahisa

AU - Kurihara, Chitaru

AU - Kawabori, Masashi

AU - Critsinelis, Andre C.

AU - Wang, Suwei

AU - Civitello, Andrew B.

AU - Rosengart, Todd K.

AU - Frazier, O. H.

AU - Morgan, Jeffrey A.

PY - 2019/10

Y1 - 2019/10

N2 - Objective: Long-term support with continuous-flow left ventricular assist devices (CF-LVADs) has improved the outcomes of patients with end-stage heart failure. However, valve disease management in patients who undergo CF-LVAD implantation remains controversial. The aim of this study was to assess our single-center experience with patients who underwent a concomitant valve procedure during implantation of a CF-LVAD. Methods: From November 2003 through March 2016, 526 patients underwent primary CF-LVAD implantation with a HeartMate II (St Jude Inc, St Paul, Minn; n = 403) or HeartWare (Medtronic, Minneapolis, Minn; n = 123) device at our center. Of those, 91 underwent a concomitant valve procedure during implantation (CF-LVAD+valve procedure group), whereas 435 did not (CF-LVAD–only group). We compared preoperative characteristics and short-term and mid-term survival rates between these groups. Results: The concomitant valve procedures performed included 13 tricuspid valve repairs, 19 aortic valve repairs or replacements, 30 mitral valve repairs or replacements, and 29 double valve repairs or replacements. Survival rates at 1 month, 6 months, 12 months, and 24 months were 90.3%, 81.4%, 74.9%, and 67.4%, respectively, for the CF-LVAD–only group and 89.0%, 75.8%, 70.3%, and 65.9%, respectively, for the CF-LVAD+valve procedure group (P = .55). The results of Cox regression multivariable modeling showed that performing a concomitant valve procedure was not an independent predictor of mortality (hazard ratio, 1.29; 95% confidence interval, 0.96-1.74; P = .08). Conclusions: In our experience, performing a concomitant valve procedure during CF-LVAD implantation was not associated with an increased mortality rate. The decision to perform a concomitant valve procedure should be made primarily on the basis of clinical indications for the procedure.

AB - Objective: Long-term support with continuous-flow left ventricular assist devices (CF-LVADs) has improved the outcomes of patients with end-stage heart failure. However, valve disease management in patients who undergo CF-LVAD implantation remains controversial. The aim of this study was to assess our single-center experience with patients who underwent a concomitant valve procedure during implantation of a CF-LVAD. Methods: From November 2003 through March 2016, 526 patients underwent primary CF-LVAD implantation with a HeartMate II (St Jude Inc, St Paul, Minn; n = 403) or HeartWare (Medtronic, Minneapolis, Minn; n = 123) device at our center. Of those, 91 underwent a concomitant valve procedure during implantation (CF-LVAD+valve procedure group), whereas 435 did not (CF-LVAD–only group). We compared preoperative characteristics and short-term and mid-term survival rates between these groups. Results: The concomitant valve procedures performed included 13 tricuspid valve repairs, 19 aortic valve repairs or replacements, 30 mitral valve repairs or replacements, and 29 double valve repairs or replacements. Survival rates at 1 month, 6 months, 12 months, and 24 months were 90.3%, 81.4%, 74.9%, and 67.4%, respectively, for the CF-LVAD–only group and 89.0%, 75.8%, 70.3%, and 65.9%, respectively, for the CF-LVAD+valve procedure group (P = .55). The results of Cox regression multivariable modeling showed that performing a concomitant valve procedure was not an independent predictor of mortality (hazard ratio, 1.29; 95% confidence interval, 0.96-1.74; P = .08). Conclusions: In our experience, performing a concomitant valve procedure during CF-LVAD implantation was not associated with an increased mortality rate. The decision to perform a concomitant valve procedure should be made primarily on the basis of clinical indications for the procedure.

KW - concomitant valve procedures

KW - heart failure

KW - left ventricular assist device

KW - valve disease

UR - http://www.scopus.com/inward/record.url?scp=85062945559&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062945559&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2019.02.040

DO - 10.1016/j.jtcvs.2019.02.040

M3 - Article

C2 - 30904255

AN - SCOPUS:85062945559

VL - 158

SP - 1083-1089.e1

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 4

ER -