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Hemodynamic Effects of Concomitant Mitral Valve Surgery and Left Ventricular Assist Device Implantation

Imamura, Teruhiko*; Nnanabu, Jerry*; Rodgers, Daniel*; Raikehlkar, Jayant*; Kalantar, Sara*; Smith, Bryan*; Nguyen, Ann*; Chung, Ben*; Narang, Nikhil*; Ota, Takeyoshi; Song, Tae; Burkhoff, Daniel; Jeevanandam, Valluvan; Kim, Gene*; Sayer, Gabriel*; Uriel, Nir*

doi: 10.1097/MAT.0000000000000999
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There are conflicting data regarding whether concomitant mitral valve surgery (MVS) at left ventricular assist device (LVAD) implantation is beneficial. This study aimed to assess the hemodynamic effects of concomitant MVS. Of all 73 enrolled patients, 44 patients had undergone concomitant MVS and 29 patients had not. Before LVAD implantation, MVS group had higher pulmonary capillary wedge pressure (p = 0.04). After LVAD implantation, MVS group had higher mean pulmonary artery pressure and cardiac output (CO). During the hemodynamic ramp study, MVS group had steeper CO slopes (0.18 [0.13 0.28] vs. 0.15 [0.08, 0.20] L/min/step; p = 0.04) at incremental LVAD speed and achieved a higher CO at the optimized set speed (5.5 [4.7, 6.9] vs. 4.9 [4.0, 5.7] L/min; p = 0.03). One-year freedom from death or heart failure readmission was statistically comparable between the two groups (61% vs. 80%, p = 0.20). Thus far, after LVAD implantation and concomitant MVS, patients had increased pulmonary hypertension, despite having higher CO and a better response of CO at incremental LVAD speed. The implication of hemodynamic features after concomitant MVS on clinical outcomes warrants further investigation.

From the *Department of Medicine; University of Chicago Medical Center, Chicago, Illinois

Department of Surgery, University of Chicago Medical Center, Chicago, Illinois

Columbia University Medical Center, and Cardiovascular Research Foundation, New York, New York.

Submitted for consideration November 2018; accepted for publication in revised form February 2019.

Disclosure: Teruhiko Imamura receives financial support from Postdoctoral Fellowship for Research Abroad of Japan Society for the Promotion of Science. Nir Uriel receives grant support from Abbott and Medtronic. Gabriel Sayer is a consultant for Medtronic. Valluvan Jeevanandam is a consultant for Abbott. Daniel Burkhoff is a consultant for Medtronic. The other authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com)

The first two authors provided equal contribution.

Correspondence: Nir Uriel, MD, MSc, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL 60637. Email: nuriel@medicine.bsd.uchicago.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs