Journal article
Impact of left ventricular assist device implantation on mitral regurgitation: An analysis from the MOMENTUM 3 trial
The Journal of heart and lung transplantation, v 39(6), pp 529-537
01 Jun 2020
PMID: 32279919
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND: Mitral regurgitation (MR) determines pathophysiology and outcome in advanced heart failure. The impact of left ventricular assist device (LVAD) placement on clinically significant MR and its contribution to long-term outcomes has been sparsely evaluated.
METHODS: We evaluated the effect of clinically significant MR on patients implanted in the MOMENTUM 3 trial with either the HeartMate II (HMII) or the HeartMate 3 (HM3) at 2 years. Clinical significance was defined as moderate or severe grade MR determined by site-based echocardiograms.
RESULTS: Of 927 patients with LVAD implants without a prior or concomitant mitral valve procedure, 403 (43.5%) had clinically significant MR at baseline. At 1-month of support, residual MR was present in 6.2% of patients with HM3 and 14.3% of patients with HMII (relative risk = 0.43; 95% CI, 0.22 -0.84; p = 0.01) with a low rate of worsening at 2 years. Residual MR at 1-month post-implant did not impact 2-year mortality for either the HM3 (hazard ratio [HR],1.41; 95% CI, 0.52-3.89; p = 0.50) or HMII (HR, 0.91; 95% CI, 0.37-2.26; p = 0.84) LVAD. The presence or absence of baseline MR did not influence mortality (HM3 HR, 0.86; 95% CI, 0.56-1.33; p = 0.50; HMII HR, 0.81; 95% CI, 0.54 -1.22; p = 0.32), major adverse events or functional capacity. In multivariate analysis, severe baseline MR (p = 0.001), larger left ventricular dimension (p = 0.002), and implantation with the HMII instead of the HM3 LVAD (p = 0.05) were independently associated with an increased likelihood of persistent MR post-implant.
CONCLUSIONS: Hemodynamic unloading after LVAD implantation improves clinically significant MR early, sustainably, and to a greater extent with the HM3 LVAD. Neither baseline nor residual MR influence outcomes after LVAD implantation. (C) 2020 The Author(s). Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation.
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Details
- Title
- Impact of left ventricular assist device implantation on mitral regurgitation: An analysis from the MOMENTUM 3 trial
- Creators
- Manreet K. Kanwar - Allegheny General HospitalKeshava Rajagopal - Memorial HermannAkinobu Itoh - Washington University in St. LouisScott C. Silvestry - AdventHlth Transplant Inst, Orlando, FL USANir Uriel - Presbyterian HospitalJoseph C. Cleveland - University of Colorado DenverChristopher T. Salerno - St Vincent HospitalDouglas Horstmanshof - INTEGRIS Baptist Medical CenterDaniel J. Goldstein - Albert Einstein College of MedicineYoshifumi Naka - Presbyterian HospitalStephen Bailey - Allegheny General HospitalIgor D. Gregoric - Memorial HermannJoyce Chuang - Abbott FundPoornima Sood - Abbott FundMandeep R. Mehra - Brigham and Women's Hospital
- Publication Details
- The Journal of heart and lung transplantation, v 39(6), pp 529-537
- Publisher
- Elsevier
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiothoracic Surgery; Cardiology
- Web of Science ID
- WOS:000539412400004
- Scopus ID
- 2-s2.0-85082930925
- Other Identifier
- 991021932192004721
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- Collaboration types
- Industry collaboration
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery
- Transplantation