Impact of left ventricular assist device implantation on mitral regurgitation: An analysis from the MOMENTUM 3 trial

Manreet K. Kanwar, Keshava Rajagopal, Akinobu Itoh, Scott C. Silvestry, Nir Uriel, Joseph C. Cleveland, Christopher T. Salerno, Douglas Horstmanshof, Daniel J. Goldstein, Yoshifumi Naka, Stephen Bailey, Igor D. Gregoric, Joyce Chuang, Poornima Sood, Mandeep R. Mehra

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Abstract

BACKGROUND: Mitral regurgitation (MR) determines pathophysiology and outcome in advanced heart failure. The impact of left ventricular assist device (LVAD) placement on clinically significant MR and its contribution to long-term outcomes has been sparsely evaluated. METHODS: We evaluated the effect of clinically significant MR on patients implanted in the MOMENTUM 3 trial with either the HeartMate II (HMII) or the HeartMate 3 (HM3) at 2 years. Clinical significance was defined as moderate or severe grade MR determined by site-based echocardiograms. RESULTS: Of 927 patients with LVAD implants without a prior or concomitant mitral valve procedure, 403 (43.5%) had clinically significant MR at baseline. At 1-month of support, residual MR was present in 6.2% of patients with HM3 and 14.3% of patients with HMII (relative risk = 0.43; 95% CI, 0.22–0.84; p = 0.01) with a low rate of worsening at 2 years. Residual MR at 1-month post-implant did not impact 2-year mortality for either the HM3 (hazard ratio [HR],1.41; 95% CI, 0.52–3.89; p = 0.50) or HMII (HR, 0.91; 95% CI, 0.37–2.26; p = 0.84) LVAD. The presence or absence of baseline MR did not influence mortality (HM3 HR, 0.86; 95% CI, 0.56–1.33; p = 0.50; HMII HR, 0.81; 95% CI, 0.54–1.22; p = 0.32), major adverse events or functional capacity. In multivariate analysis, severe baseline MR (p = 0.001), larger left ventricular dimension (p = 0.002), and implantation with the HMII instead of the HM3 LVAD (p = 0.05) were independently associated with an increased likelihood of persistent MR post-implant. CONCLUSIONS: Hemodynamic unloading after LVAD implantation improves clinically significant MR early, sustainably, and to a greater extent with the HM3 LVAD. Neither baseline nor residual MR influence outcomes after LVAD implantation.

Original languageEnglish (US)
Pages (from-to)529-537
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume39
Issue number6
DOIs
StatePublished - Jun 2020

Keywords

  • LVAD
  • mitral regurgitation
  • outcomes, MOMENTUM 3, HeartMate 3

ASJC Scopus subject areas

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

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    Kanwar, M. K., Rajagopal, K., Itoh, A., Silvestry, S. C., Uriel, N., Cleveland, J. C., Salerno, C. T., Horstmanshof, D., Goldstein, D. J., Naka, Y., Bailey, S., Gregoric, I. D., Chuang, J., Sood, P., & Mehra, M. R. (2020). Impact of left ventricular assist device implantation on mitral regurgitation: An analysis from the MOMENTUM 3 trial. Journal of Heart and Lung Transplantation, 39(6), 529-537. https://doi.org/10.1016/j.healun.2020.03.003