Early outcomes of domestic left ventricular assist device implantation with or without concomitant mitral valvuloplasty_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Zhihua ¹ , ZHAO Zeyuan ¹ , HU Junlong ¹ , SUN Junjie ¹ , LIU Kun ² , DUAN Xiaoxia ¹ , WANG Sheng ¹ ,  CHENG Zhaoyun ¹

1. Department of Cardiac Surgery, Zhengzhou University Affiliated Fuwai Central China Cardiovascular Hospital, Zhengzhou, 451464,P. R. China;
2. Department of Cardiac Surgery, Cardiovascular Medical Center, the University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053,Guangdong, P. R. China;

Corresponding author：

CHENG Zhaoyun, Email: Chengzhy@zzu.edu.cn

Keywords：

Heart failure; left ventricular assist device; mitral regurgitation; mitral valvuloplasty; early outcomes

DOI：

10.7507/1007-4848.202304027

Video：

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Objective To compare the early outcomes of domestic third-generation magnetically levitated left ventricular assist device (LVAD) with or without concomitant mitral valvuloplasty (MVP). Methods The clinical data of 17 end-stage heart failure patients who underwent LVAD implantation combined with preoperative moderate to severe mitral regurgitation in Fuwai Central China Cardiovascular Hospital from May 2018 to March 2023 were retrospectively analyzed. The patients were divided into a LVAD group and a LVAD+MVP group based on whether MVP was performed simultaneously, and early outcomes were compared between the two groups. Results There were 4 patients in the LVAD group, all males, aged (43.5±5.9) years, and 13 patients in the LVAD+MVP group, including 10 males and 3 females, aged (46.8±16.7) years. All the patients were successful in concomitant MVP without mitral reguragitation occurrence. Compared with the LVAD group, the LVAD+MVP group had a lower pulmonary artery systolic pressure and pulmonary artery mean pressure 72 h after operation, but the difference was not statistically different (P>0.05). Pulmonary artery systolic pressure was significantly lower 1 week after operation, as well as pulmonary artery systolic blood pressure and pulmonary artery mean pressure at 1 month after operation (P<0.01). There was no statistically significant difference in blood loss, operation time, cardiopulmonary bypass time, aortic cross-clamping time, mechanical ventilation time, or ICU stay time between the two groups (P>0.05). The differences in 1-month postoperative mortality, acute kidney injury, reoperation, gastrointestinal bleeding, and thrombosis and other complications between the two groups were not statistically significant (P>0.05). Conclusion Concomitant MVP with implantation of domestic third-generation magnetically levitated LVAD is safe and feasible, and concomitant MVP may improve postoperative hemodynamics without significantly increasing perioperative mortality and complication rates.

Citation： WANG Zhihua, ZHAO Zeyuan, HU Junlong, SUN Junjie, LIU Kun, DUAN Xiaoxia, WANG Sheng, CHENG Zhaoyun. Early outcomes of domestic left ventricular assist device implantation with or without concomitant mitral valvuloplasty. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(11): 1599-1605. doi: 10.7507/1007-4848.202304027 Copy

1.	袁莉, 孙晓宁, 王春生. 左心室辅助装置治疗心力衰竭的现状及进展. 中国胸心血管外科临床杂志, 2022, 29(4): 508-513.Yuan L, Sun XL, Wang CS. Current status and progress of left ventricular assist device for end-stage heart failure. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(4): 508-513.
2.	Riebandt J, Schaefer A, Wiedemann D, et al. Concomitant cardiac surgery procedures during left ventricular assist device implantation: Single-centre experience. Ann Cardiothorac Surg, 2021, 10(2): 248-254.
3.	Jain R, Truby LK, Topkara VK. Residual mitral regurgitation in patients with left ventricular assist device support - An INTERMACS analysis. J Heart Lung Transplant, 2022, 41(11): 1638-1645.
4.	Rajapreyar I, Rame JE, Fiorilli P, et al. Pathological insights into persistent mitral regurgitation following continuous flow left ventricular assist device implantation. J Heart Lung Transplant, 2020, 39(2): 184-186.
5.	Okoh A, Yanagida R, Schultheis M, et al. Impact of baseline mitral regurgitation on postoperative outcomes after left ventricular assist device implantation as destination therapy. Transplant Proc, 2019, 51(5): 1636-1636.
6.	Pawale A, Itagaki S, Parikh A, et al. Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation. J Thorac Cardiovasc Surg, 2019, 157(5): 1841-1848.
7.	Kawabori M, Kurihara C, Conyer R T, et al. Effect of concomitant mitral valve procedures for severe mitral regurgitation during left ventricular assist device implantation. J Artif Organs, 2019, 22(2): 91-97.
8.	McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J, 2021, 42(36): 3599-3726.
9.	郭颖, 张瑞生. 中国成人心脏瓣膜病超声心动图规范化检查专家共识. 中国循环杂志, 2021, 36(2): 109-125.Guo Y, Zhang RS. Expert consensus for standard assessment by echocardiography in chinese adults with valvular heart disease. Chin Circulation J, 2021, 36(2): 109-125.
10.	Feldman D, Pamboukian SV, Teuteberg JJ, et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: Executive summary. J Heart Lung Transplant, 2013, 32(2): 157-187.
11.	Potapov EV, Antonides C, Crespo-Leiro MG, et al. 2019 EACTS expert consensus on long-term mechanical circulatory support. Eur J Cardiothorac Surg, 2019, 56(2): 230-270.
12.	Robertson JO, Naftel DC, Myers SL, et al. Concomitant mitral valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: An INTERMACS database analysis. J Heart Lung Transplant, 2018, 37(1): 79-88.
13.	Tanaka A, Onsager D, Song T, et al. Surgically corrected mitral regurgitation during left ventricular assist device implantation is associated with low recurrence rate and improved midterm survival. Ann Thorac Surg, 2017, 103(3): 725-733.
14.	Sandoval E, Singh SK, Carillo JA, et al. Impact of concomitant mitral valve repair for severe mitral regurgitation at the time of continuous-flow left ventricular assist device insertion. Interact Cardiovasc Thorac Surg, 2017, 25(4): 620-623.
15.	Fukuhara S, Takeda K, Chiuzan C, et al. Concomitant mitral repair and continuous—Flow left ventricular assist devices: Is it warranted?. J Thorac Cardiovasc Surg, 2017, 154(4): 1303-1312.
16.	Lee HW, Jung JW, Kim AY, et al. Heart transplantation in a patient with complex congenital heart disease, physiologic single lung, and severe pulmonary hypertension. Yonsei Med J, 2022, 63(12): 1144-1146.
17.	Loforte A, de By T, Gliozzi G, et al. Impact of concomitant cardiac valvular surgery during implantation of continuous-flow left ventricular assist devices: A European registry for patients with mechanical circulatory support (EUROMACS) analysis. Artif Organs, 2022, 46(5): 813-826.
18.	John R, Kanwar MK, Cleveland JC, Jr. , et al. Concurrent valvular procedures during left ventricular assist device implantation and outcomes: A comprehensive analysis of the multicenter study of maglev technology in patients undergoing mechanical circulatory support therapy with heartmate 3 trial portfolio. J Thorac Cardiovasc Surg, 2022, 21(4): 1-11.
19.	Iqbal K, Arif TB, Rathore SS, et al. Outcomes of concomitant aortic valve procedures and left ventricular assist device implantation: A systematic review and meta-analysis. Artif Organs, 2023, 47(3): 470-480.
20.	Asleh R, Schettle S, Briasoulis A, et al. Predictors and outcomes of renal replacement therapy after left ventricular assist device implantation. Mayo Clin Proc, 2019, 94(6): 1003-1014.
21.	雷白. 左心室辅助装置抗栓治疗研究进展. 中国循环杂志, 2020, 35(2): 200-205.Lei B. Research progress on antithrombotic therapy with left ventricular assist devices. Chin Circulation J, 2020, 35(2): 200-205.
22.	Stulak JM, Davis ME, Haglund N, et al. Adverse events in contemporary continuous-flow left ventricular assist devices: A multi-institutional comparison shows significant differences. J Thorac Cardiovasc Surg, 2016, 151(1): 177-189.
23.	Stulak JM, Lee D, Haft JW, et al. Gastrointestinal bleeding and subsequent risk of thromboembolic events during support with a left ventricular assist device. J Heart Lung Transplant, 2014, 33(1): 60-64.
24.	Del Rio-Pertuz G, Nair N. Gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices: A comprehensive review. Artif Organs, 2023, 47(1): 12-23.
25.	Okoh A, Yanagida R, Schultheis M, et al. Impact of baseline mitral regurgitation on postoperative outcomes after left ventricular assist device implantation as destination therapy. Transplant Proc, 2019, 51(3): 859-864.

1. 袁莉, 孙晓宁, 王春生. 左心室辅助装置治疗心力衰竭的现状及进展. 中国胸心血管外科临床杂志, 2022, 29(4): 508-513.Yuan L, Sun XL, Wang CS. Current status and progress of left ventricular assist device for end-stage heart failure. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(4): 508-513.
2. Riebandt J, Schaefer A, Wiedemann D, et al. Concomitant cardiac surgery procedures during left ventricular assist device implantation: Single-centre experience. Ann Cardiothorac Surg, 2021, 10(2): 248-254.
3. Jain R, Truby LK, Topkara VK. Residual mitral regurgitation in patients with left ventricular assist device support - An INTERMACS analysis. J Heart Lung Transplant, 2022, 41(11): 1638-1645.
4. Rajapreyar I, Rame JE, Fiorilli P, et al. Pathological insights into persistent mitral regurgitation following continuous flow left ventricular assist device implantation. J Heart Lung Transplant, 2020, 39(2): 184-186.
5. Okoh A, Yanagida R, Schultheis M, et al. Impact of baseline mitral regurgitation on postoperative outcomes after left ventricular assist device implantation as destination therapy. Transplant Proc, 2019, 51(5): 1636-1636.
6. Pawale A, Itagaki S, Parikh A, et al. Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation. J Thorac Cardiovasc Surg, 2019, 157(5): 1841-1848.
7. Kawabori M, Kurihara C, Conyer R T, et al. Effect of concomitant mitral valve procedures for severe mitral regurgitation during left ventricular assist device implantation. J Artif Organs, 2019, 22(2): 91-97.
8. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J, 2021, 42(36): 3599-3726.
9. 郭颖, 张瑞生. 中国成人心脏瓣膜病超声心动图规范化检查专家共识. 中国循环杂志, 2021, 36(2): 109-125.Guo Y, Zhang RS. Expert consensus for standard assessment by echocardiography in chinese adults with valvular heart disease. Chin Circulation J, 2021, 36(2): 109-125.
10. Feldman D, Pamboukian SV, Teuteberg JJ, et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: Executive summary. J Heart Lung Transplant, 2013, 32(2): 157-187.
11. Potapov EV, Antonides C, Crespo-Leiro MG, et al. 2019 EACTS expert consensus on long-term mechanical circulatory support. Eur J Cardiothorac Surg, 2019, 56(2): 230-270.
12. Robertson JO, Naftel DC, Myers SL, et al. Concomitant mitral valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: An INTERMACS database analysis. J Heart Lung Transplant, 2018, 37(1): 79-88.
13. Tanaka A, Onsager D, Song T, et al. Surgically corrected mitral regurgitation during left ventricular assist device implantation is associated with low recurrence rate and improved midterm survival. Ann Thorac Surg, 2017, 103(3): 725-733.
14. Sandoval E, Singh SK, Carillo JA, et al. Impact of concomitant mitral valve repair for severe mitral regurgitation at the time of continuous-flow left ventricular assist device insertion. Interact Cardiovasc Thorac Surg, 2017, 25(4): 620-623.
15. Fukuhara S, Takeda K, Chiuzan C, et al. Concomitant mitral repair and continuous—Flow left ventricular assist devices: Is it warranted?. J Thorac Cardiovasc Surg, 2017, 154(4): 1303-1312.
16. Lee HW, Jung JW, Kim AY, et al. Heart transplantation in a patient with complex congenital heart disease, physiologic single lung, and severe pulmonary hypertension. Yonsei Med J, 2022, 63(12): 1144-1146.
17. Loforte A, de By T, Gliozzi G, et al. Impact of concomitant cardiac valvular surgery during implantation of continuous-flow left ventricular assist devices: A European registry for patients with mechanical circulatory support (EUROMACS) analysis. Artif Organs, 2022, 46(5): 813-826.
18. John R, Kanwar MK, Cleveland JC, Jr. , et al. Concurrent valvular procedures during left ventricular assist device implantation and outcomes: A comprehensive analysis of the multicenter study of maglev technology in patients undergoing mechanical circulatory support therapy with heartmate 3 trial portfolio. J Thorac Cardiovasc Surg, 2022, 21(4): 1-11.
19. Iqbal K, Arif TB, Rathore SS, et al. Outcomes of concomitant aortic valve procedures and left ventricular assist device implantation: A systematic review and meta-analysis. Artif Organs, 2023, 47(3): 470-480.
20. Asleh R, Schettle S, Briasoulis A, et al. Predictors and outcomes of renal replacement therapy after left ventricular assist device implantation. Mayo Clin Proc, 2019, 94(6): 1003-1014.
21. 雷白. 左心室辅助装置抗栓治疗研究进展. 中国循环杂志, 2020, 35(2): 200-205.Lei B. Research progress on antithrombotic therapy with left ventricular assist devices. Chin Circulation J, 2020, 35(2): 200-205.
22. Stulak JM, Davis ME, Haglund N, et al. Adverse events in contemporary continuous-flow left ventricular assist devices: A multi-institutional comparison shows significant differences. J Thorac Cardiovasc Surg, 2016, 151(1): 177-189.
23. Stulak JM, Lee D, Haft JW, et al. Gastrointestinal bleeding and subsequent risk of thromboembolic events during support with a left ventricular assist device. J Heart Lung Transplant, 2014, 33(1): 60-64.
24. Del Rio-Pertuz G, Nair N. Gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices: A comprehensive review. Artif Organs, 2023, 47(1): 12-23.
25. Okoh A, Yanagida R, Schultheis M, et al. Impact of baseline mitral regurgitation on postoperative outcomes after left ventricular assist device implantation as destination therapy. Transplant Proc, 2019, 51(3): 859-864.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early outcomes of domestic left ventricular assist device implantation with or without concomitant mitral valvuloplasty

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