Journal article
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
The Journal of thoracic and cardiovascular surgery, v 166(6), pp 1684-1694
01 Dec 2023
PMID: 35643769
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Correction of valvular disease is often undertaken during left ventricular assist device (LVAD) implantation with uncertain benefit. We analyzed clinical outcomes with HeartMate 3 (HM3; Abbott) LVAD implantation in those with various concurrent valve procedures (HM3+VP) with those with an isolated LVAD implant (HM3 alone).
The study included 2200 patients with HM3 implanted within the Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 (MOMENTUM 3) trial portfolio who underwent 820 concurrent procedures among which 466 (21.8%) were HM3+VP. VPs included 101 aortic, 61 mitral, 163 tricuspid; 85 patients had multiple VPs. Perioperative complications, major adverse events, and survival were analyzed.
Patients who underwent HM3+VP had higher-acuity Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles (1-2: 41% vs 31%) compared with no VPs (P < .05). The cardiopulmonary bypass time (124 vs 76 minutes; P < .0001) and hospital length of stay (20 vs 18 days; P < .0001) were longer in HM3+VP. A higher incidence of stroke (4.9% vs 2.4%), bleeding (33.9% vs 23.8%), and right heart failure (41.5% vs 29.6%) was noted in HM3+VP at 0 to 30 days (P < .01), with no difference in 30-day mortality (3.9% vs 3.3%) or 2-year survival (81.7% vs 80.8%). Analysis of individual VP showed no differences in survival compared to HM3 alone. No differences were noted among patients with either significant mitral (moderate or worse) or tricuspid (moderate or worse) regurgitation with or without corrective surgery.
Concurrent VPs, commonly performed during LVAD implantation, are associated with increased morbidity during the index hospitalization, with no effect on short- and long-term survival. There is sufficient equipoise to consider a randomized trial on the benefit of commonly performed VPs (such as mitral or tricuspid regurgitation correction), during LVAD implantation.
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Details
- Title
- 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
- Creators
- Ranjit John - University of Minnesota Medical CenterManreet K. Kanwar - Allegheny Health NetworkJoseph C. Cleveland - University of Colorado DenverNir Uriel - Columbia UniversityYoshifumi Naka - Cornell UniversityChristopher Salerno - University of Chicago Medical CenterDouglas Horstmanshof - INTEGRIS Baptist Medical CenterShelley A. Hall - Baylor University Medical CenterJennifer A. Cowger - Henry Ford Health SystemGerald Heatley - AbbottSami I. Somo - AbbottMandeep R. Mehra - Brigham and Women's Hospital
- Publication Details
- The Journal of thoracic and cardiovascular surgery, v 166(6), pp 1684-1694
- Publisher
- Elsevier
- Grant note
- CAP (https://doi.org/10.13039/100010655) Abbott (https://doi.org/10.13039/100000046)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiology
- Web of Science ID
- WOS:001113506300001
- Scopus ID
- 2-s2.0-85130897242
- Other Identifier
- 991021932096604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery