Changes in Mitral Valve Apparatus with Continuous Flow LVAD

Purpose The purpose of this research was to study the changes in mitral valve apparatus after placement of continuous flow LVAD. These data can help determine if additional mitral valve intervention is needed at the time of LVAD placement. Methods A retrospective review of data of all the LVAD placed in the hospital from 2012 through March 31st 2020 were done. Demographic, clinical variables and clinical outcomes were obtained from electronic medical records. The echocardiographic variables were obtained by two authors with standardized guidelines agreed upon before initiation of the study; this required review of all the images and identification of some unique variables dedicated to the study of mitral valve apparatus. The echocardiogram performed closest before LVAD placement and the last echocardiogram performed within one year after LVAD placement were evaluated to allow reflection of the worst pre-LVAD and the best post-LVAD state of the mitral valve apparatus. Results Of total of 145 patients who had LVAD during the study period, 88 patients were identified with pre-specified minimum available echocardiographic variables. 9 did not have significant pre-existing mitral regurgitation (MR). 69 patients had improvement from “moderate or severe” to “mild or none”. 10 patients did not show any improvement in the severity of MR: 8 from mild and 2 from moderate MR. All severe MR improved. The changes in mitral valve apparatus included (all reduction): left ventricular end diastolic dimension by 9 (+/-14.98) mm; left atrial volume index by 16.2 (+/- 14.73) ml/m2; annulus size by 5 (+/- 7.94) mm; apical displacement by 2 (+/- 3.91) mm; posterior displacement by 2 (+/- 4.7) mm; tethering area by 85 (+/- 104.94) mm2 and papillary muscle displacement by 2 (+/- 9.55) mm. Changes in mitral valve apparatus were similar in those who had improvement of MR or not except the reduction in posterior displacement happened more in those who had improvement in MR severity. Conclusion Continuous flow LVAD favorably improves mitral valve apparatus and MR severity. Prevalence of clinically significant residual MR is low. More data is needed to understand the changes in mitral valve apparatus and guide if any concomitant mitral valve intervention is needed with LVAD placement. The purpose of this research was to study the changes in mitral valve apparatus after placement of continuous flow LVAD. These data can help determine if additional mitral valve intervention is needed at the time of LVAD placement. A retrospective review of data of all the LVAD placed in the hospital from 2012 through March 31st 2020 were done. Demographic, clinical variables and clinical outcomes were obtained from electronic medical records. The echocardiographic variables were obtained by two authors with standardized guidelines agreed upon before initiation of the study; this required review of all the images and identification of some unique variables dedicated to the study of mitral valve apparatus. The echocardiogram performed closest before LVAD placement and the last echocardiogram performed within one year after LVAD placement were evaluated to allow reflection of the worst pre-LVAD and the best post-LVAD state of the mitral valve apparatus. Of total of 145 patients who had LVAD during the study period, 88 patients were identified with pre-specified minimum available echocardiographic variables. 9 did not have significant pre-existing mitral regurgitation (MR). 69 patients had improvement from “moderate or severe” to “mild or none”. 10 patients did not show any improvement in the severity of MR: 8 from mild and 2 from moderate MR. All severe MR improved. The changes in mitral valve apparatus included (all reduction): left ventricular end diastolic dimension by 9 (+/-14.98) mm; left atrial volume index by 16.2 (+/- 14.73) ml/m2; annulus size by 5 (+/- 7.94) mm; apical displacement by 2 (+/- 3.91) mm; posterior displacement by 2 (+/- 4.7) mm; tethering area by 85 (+/- 104.94) mm2 and papillary muscle displacement by 2 (+/- 9.55) mm. Changes in mitral valve apparatus were similar in those who had improvement of MR or not except the reduction in posterior displacement happened more in those who had improvement in MR severity. Continuous flow LVAD favorably improves mitral valve apparatus and MR severity. Prevalence of clinically significant residual MR is low. More data is needed to understand the changes in mitral valve apparatus and guide if any concomitant mitral valve intervention is needed with LVAD placement.