Abstract | BACKGROUND: METHODS: Between October 1996 and August 2013, 756 patients underwent primary LVAD implantation at our institutions. Of these, 508 patients received a continuous-flow LVAD and represent the contemporary cohort for this analysis. Devices implanted included the HeartMate II in 410 patients (81%) and HeartWare HVAD in 98 patients (19%). Based on availability of pre-operative echocardiography, 491 patients were divided into 2 study groups according to degree of pre-operative MR; 189 patients (39%) had moderate to severe or greater MR (MR group), and 302 (61%) had less than moderate to severe MR (less MR group). Median age at operation (60 years in MR group vs 58 years in less MR group, p = 0.19), male sex (78% in MR group vs 81% in less MR group, p = 0.42), and ischemic etiology (46% in MR group vs 51% in less MR group, p = 0.35) were similar between groups. RESULTS: There were 40 early deaths (7.9%), and follow-up was available in all 468 early survivors for 641 patient-years of support. Patients in the MR group had higher late survival (2 years, 75%; 4 years, 65%) compared with patients in the less MR group (2 years, 66%; 4 years, 48%; p < 0.04). Cox proportional hazards model confirmed the independent interaction between MR and late survival (hazard ratio 0.62, p = 0.04). CONCLUSIONS: There was improved survival in patients with severe pre-operative MR after continuous-flow LVAD implantation in our cohort. These findings may lend insight into the possible lack of value of addressing significant MR at the time of LVAD implantation.
|
Authors | John M Stulak, Vakhtang Tchantchaleishvili, Nicholas A Haglund, Mary E Davis, John A Schirger, Jennifer A Cowger, Palak Shah, Keith D Aaronson, Francis D Pagani, Simon Maltais |
Journal | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
(J Heart Lung Transplant)
Vol. 34
Issue 5
Pg. 718-23
(May 2015)
ISSN: 1557-3117 [Electronic] United States |
PMID | 25697807
(Publication Type: Journal Article, Multicenter Study)
|
Copyright | Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. |
Topics |
- Aged
- Echocardiography
- Female
- Follow-Up Studies
- Heart Failure
(complications, mortality, surgery)
- Heart-Assist Devices
- Humans
- Incidence
- Male
- Middle Aged
- Mitral Valve Insufficiency
(complications, epidemiology, therapy)
- Prognosis
- Retrospective Studies
- Survival Rate
(trends)
- Treatment Outcome
- United States
(epidemiology)
|