Safety, Mortality, and Hemodynamic Impact of Patients with MitraClip Undergoing Left Ventricular Assist Device Implantation

J Cardiovasc Transl Res. 2022 Jun;15(3):676-686. doi: 10.1007/s12265-021-10178-w. Epub 2021 Oct 28.

Abstract

The interactions and hemodynamic impact of transcatheter percutaneous mitral valve repair (TMR) have not yet been investigated in patients undergoing left ventricular assist device (LVAD) implantation, but hemodynamic adverse effects are feared in the combination of TMR and LVAD for altered mitral valve flow. This study investigated the hemodynamic interplay in combination of TMR and LVAD in 119 patients, and propensity score match analysis revealed no difference in both perioperative mortality and 2-year follow-up survival (p = 0.84). Nonetheless, postoperatively mean pulmonary arterial pressure, pulmonary capillary wedge pressure, and cardiac index improved, and multivariable cox regression analysis at 2 years identified preoperative total bilirubin and temporary right ventricular mechanical circulatory support as independent risk factors for all-cause mortality but not TMR. Prior TMR has no impact on mortality or cardiovascular complications in patients with LVAD.

Keywords: CentriMag system; Heart failure; Heart transplantation; HeartMate 3; Left ventricular assist device; Left ventricular dysfunction; Mechanical circulatory support; MitraClip; Mortality; Pulmonary artery pressure; Pulmonary vascular resistance; Transpulmonary gradient.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiac Surgical Procedures* / adverse effects
  • Heart Failure* / diagnosis
  • Heart Failure* / surgery
  • Heart-Assist Devices* / adverse effects
  • Humans
  • Pulmonary Wedge Pressure
  • Retrospective Studies
  • Treatment Outcome
  • Ventricular Dysfunction, Right*