Pre-operative echocardiographic features associated with persistent mitral regurgitation after left ventricular assist device implantation

Shuichi Kitada, Tomoko S. Kato, Sunu S. Thomas, Suzanne D. Conwell, Cesare Russo, Marco R. Di Tullio, Maryjane Farr, P. Christian Schulze, Nir Uriel, Ulrich P. Jorde, Hiroo Takayama, Yoshifumi Naka, Shunichi Homma, Donna M. Mancini

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background Previous studies have shown remarkable decrease in size of the left ventricle after left ventricular assist device (LVAD) implantation due to mechanical unloading. However, a certain number of patients continue to have significant mitral regurgitation (MR) under LVAD support. We investigated pre-operative echocardiographic features associated with persistent MR after LVAD implantation. Methods We retrospectively reviewed 82 consecutive patients undergoing continuous-flow LVAD implantation between 2007 and 2010. We obtained echocardiograms performed within 2 weeks before and 1 week after surgery. We investigated the pre-operative echocardiographic findings associated with significant MR post-LVAD and compared 1-year mortality after LVAD surgery between patients with and without significant MR post-LVAD. Results MR was significant in 43 patients (52.4%) before LVAD surgery. Among those, 5 underwent concomitant mitral valve repair (MVr) at the time of LVAD implantation. Of the remaining 38 patients, 25 (65.8%) showed improvement of MR, whereas 13 patients (34.2%) continued to have significant MR post-LVAD. Multivariate analysis revealed that posterior displacement of the coaptation point of mitral leaflets was significantly associated with significant MR post-LVAD (hazard ratio, 1.335; 95% confidence interval, 1.035-1.721; p = 0.026) even after adjusting for the amount of pre-operative MR flow. Post-LVAD 1-year survival of patients with and without significant MR post-LVAD was not significantly different (92.3% vs 89.1%, p = 0.826). Conclusions Pre-LVAD posterior displacement of mitral leaflets may be indicative of post-operative significant MR, which would help identify echocardiographic features of functional MR refractory to simple volume reduction of the ventricle.

Original languageEnglish (US)
Pages (from-to)897-904
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume32
Issue number9
DOIs
StatePublished - Sep 2013
Externally publishedYes

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Heart-Assist Devices
Mitral Valve Insufficiency
Mitral Valve
Heart Ventricles

Keywords

  • echocardiography
  • heart failure
  • mitral regurgitation
  • ventricular assist device

ASJC Scopus subject areas

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

Cite this

Pre-operative echocardiographic features associated with persistent mitral regurgitation after left ventricular assist device implantation. / Kitada, Shuichi; Kato, Tomoko S.; Thomas, Sunu S.; Conwell, Suzanne D.; Russo, Cesare; Di Tullio, Marco R.; Farr, Maryjane; Christian Schulze, P.; Uriel, Nir; Jorde, Ulrich P.; Takayama, Hiroo; Naka, Yoshifumi; Homma, Shunichi; Mancini, Donna M.

In: Journal of Heart and Lung Transplantation, Vol. 32, No. 9, 09.2013, p. 897-904.

Research output: Contribution to journalArticle

Kitada, S, Kato, TS, Thomas, SS, Conwell, SD, Russo, C, Di Tullio, MR, Farr, M, Christian Schulze, P, Uriel, N, Jorde, UP, Takayama, H, Naka, Y, Homma, S & Mancini, DM 2013, 'Pre-operative echocardiographic features associated with persistent mitral regurgitation after left ventricular assist device implantation', Journal of Heart and Lung Transplantation, vol. 32, no. 9, pp. 897-904. https://doi.org/10.1016/j.healun.2013.06.004
Kitada, Shuichi ; Kato, Tomoko S. ; Thomas, Sunu S. ; Conwell, Suzanne D. ; Russo, Cesare ; Di Tullio, Marco R. ; Farr, Maryjane ; Christian Schulze, P. ; Uriel, Nir ; Jorde, Ulrich P. ; Takayama, Hiroo ; Naka, Yoshifumi ; Homma, Shunichi ; Mancini, Donna M. / Pre-operative echocardiographic features associated with persistent mitral regurgitation after left ventricular assist device implantation. In: Journal of Heart and Lung Transplantation. 2013 ; Vol. 32, No. 9. pp. 897-904.
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title = "Pre-operative echocardiographic features associated with persistent mitral regurgitation after left ventricular assist device implantation",
abstract = "Background Previous studies have shown remarkable decrease in size of the left ventricle after left ventricular assist device (LVAD) implantation due to mechanical unloading. However, a certain number of patients continue to have significant mitral regurgitation (MR) under LVAD support. We investigated pre-operative echocardiographic features associated with persistent MR after LVAD implantation. Methods We retrospectively reviewed 82 consecutive patients undergoing continuous-flow LVAD implantation between 2007 and 2010. We obtained echocardiograms performed within 2 weeks before and 1 week after surgery. We investigated the pre-operative echocardiographic findings associated with significant MR post-LVAD and compared 1-year mortality after LVAD surgery between patients with and without significant MR post-LVAD. Results MR was significant in 43 patients (52.4{\%}) before LVAD surgery. Among those, 5 underwent concomitant mitral valve repair (MVr) at the time of LVAD implantation. Of the remaining 38 patients, 25 (65.8{\%}) showed improvement of MR, whereas 13 patients (34.2{\%}) continued to have significant MR post-LVAD. Multivariate analysis revealed that posterior displacement of the coaptation point of mitral leaflets was significantly associated with significant MR post-LVAD (hazard ratio, 1.335; 95{\%} confidence interval, 1.035-1.721; p = 0.026) even after adjusting for the amount of pre-operative MR flow. Post-LVAD 1-year survival of patients with and without significant MR post-LVAD was not significantly different (92.3{\%} vs 89.1{\%}, p = 0.826). Conclusions Pre-LVAD posterior displacement of mitral leaflets may be indicative of post-operative significant MR, which would help identify echocardiographic features of functional MR refractory to simple volume reduction of the ventricle.",
keywords = "echocardiography, heart failure, mitral regurgitation, ventricular assist device",
author = "Shuichi Kitada and Kato, {Tomoko S.} and Thomas, {Sunu S.} and Conwell, {Suzanne D.} and Cesare Russo and {Di Tullio}, {Marco R.} and Maryjane Farr and {Christian Schulze}, P. and Nir Uriel and Jorde, {Ulrich P.} and Hiroo Takayama and Yoshifumi Naka and Shunichi Homma and Mancini, {Donna M.}",
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T1 - Pre-operative echocardiographic features associated with persistent mitral regurgitation after left ventricular assist device implantation

AU - Kitada, Shuichi

AU - Kato, Tomoko S.

AU - Thomas, Sunu S.

AU - Conwell, Suzanne D.

AU - Russo, Cesare

AU - Di Tullio, Marco R.

AU - Farr, Maryjane

AU - Christian Schulze, P.

AU - Uriel, Nir

AU - Jorde, Ulrich P.

AU - Takayama, Hiroo

AU - Naka, Yoshifumi

AU - Homma, Shunichi

AU - Mancini, Donna M.

PY - 2013/9

Y1 - 2013/9

N2 - Background Previous studies have shown remarkable decrease in size of the left ventricle after left ventricular assist device (LVAD) implantation due to mechanical unloading. However, a certain number of patients continue to have significant mitral regurgitation (MR) under LVAD support. We investigated pre-operative echocardiographic features associated with persistent MR after LVAD implantation. Methods We retrospectively reviewed 82 consecutive patients undergoing continuous-flow LVAD implantation between 2007 and 2010. We obtained echocardiograms performed within 2 weeks before and 1 week after surgery. We investigated the pre-operative echocardiographic findings associated with significant MR post-LVAD and compared 1-year mortality after LVAD surgery between patients with and without significant MR post-LVAD. Results MR was significant in 43 patients (52.4%) before LVAD surgery. Among those, 5 underwent concomitant mitral valve repair (MVr) at the time of LVAD implantation. Of the remaining 38 patients, 25 (65.8%) showed improvement of MR, whereas 13 patients (34.2%) continued to have significant MR post-LVAD. Multivariate analysis revealed that posterior displacement of the coaptation point of mitral leaflets was significantly associated with significant MR post-LVAD (hazard ratio, 1.335; 95% confidence interval, 1.035-1.721; p = 0.026) even after adjusting for the amount of pre-operative MR flow. Post-LVAD 1-year survival of patients with and without significant MR post-LVAD was not significantly different (92.3% vs 89.1%, p = 0.826). Conclusions Pre-LVAD posterior displacement of mitral leaflets may be indicative of post-operative significant MR, which would help identify echocardiographic features of functional MR refractory to simple volume reduction of the ventricle.

AB - Background Previous studies have shown remarkable decrease in size of the left ventricle after left ventricular assist device (LVAD) implantation due to mechanical unloading. However, a certain number of patients continue to have significant mitral regurgitation (MR) under LVAD support. We investigated pre-operative echocardiographic features associated with persistent MR after LVAD implantation. Methods We retrospectively reviewed 82 consecutive patients undergoing continuous-flow LVAD implantation between 2007 and 2010. We obtained echocardiograms performed within 2 weeks before and 1 week after surgery. We investigated the pre-operative echocardiographic findings associated with significant MR post-LVAD and compared 1-year mortality after LVAD surgery between patients with and without significant MR post-LVAD. Results MR was significant in 43 patients (52.4%) before LVAD surgery. Among those, 5 underwent concomitant mitral valve repair (MVr) at the time of LVAD implantation. Of the remaining 38 patients, 25 (65.8%) showed improvement of MR, whereas 13 patients (34.2%) continued to have significant MR post-LVAD. Multivariate analysis revealed that posterior displacement of the coaptation point of mitral leaflets was significantly associated with significant MR post-LVAD (hazard ratio, 1.335; 95% confidence interval, 1.035-1.721; p = 0.026) even after adjusting for the amount of pre-operative MR flow. Post-LVAD 1-year survival of patients with and without significant MR post-LVAD was not significantly different (92.3% vs 89.1%, p = 0.826). Conclusions Pre-LVAD posterior displacement of mitral leaflets may be indicative of post-operative significant MR, which would help identify echocardiographic features of functional MR refractory to simple volume reduction of the ventricle.

KW - echocardiography

KW - heart failure

KW - mitral regurgitation

KW - ventricular assist device

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