Impact of Concomitant Valvular Surgery on Patients Undergoing LVAD Implantation

Purpose Concomitant valvular surgery at the time of left ventricular device (LVAD) implantation remains controversial. This study aims to evaluate outcomes of these patients compared to the isolated-LVAD cohort. Methods We examined 309 adult LVAD patients (2009-2018) at Stanford and identified those who underwent concomitant aortic, mitral, or tricuspid valve surgery. Pre- and post-operative data were analyzed and compared with those who underwent LVAD implantation alone. We also performed a case-control study to compare the concomitant valve-LVAD patients to those with ≥ 3+ or 4+ regurgitation (moderate and severe, respectively) who only received an LVAD. Continuous variables were analyzed using student's t test and reported as mean ± standard deviation (SD), and Wilcoxon rank-sum test with median and 1st and 3rd quartile values (Q1 and Q3). Categorical variables were analyzed using Fisher's exact test (n, %). All p-values are two tailed with Results Twenty-two patients had valvular intervention at the time of LVAD placement: 10 aortic, 11 tricuspid, and 1 mitral. Preop demographics were similar across all groups. Expectedly, intraop data showed that patients with concomitant valve surgery had greater cardiopulmonary bypass (CPB) time than those without valve surgery. They also had higher rates of OR take-backs for bleeding, tracheostomy, dialysis, post-op stroke, and overall mortality. Furthermore, patients undergoing both LVAD-TVR and LVAD-AVR subsets had longer CPB time, but the LVAD-TVR group alone was at higher risk for bleeding, tracheostomy, dialysis, longer hospital stay, and lower overall survival. (Table 1 does not include LVAD-AVR and MVR data.) Conclusion Patients undergoing concomitant valve surgery at time of LVAD placement have higher risk for increased complications and mortality when compared to the isolated-LVAD cohort. However, these risks are more apparent only in patients undergoing LVAD-TVR and not in the LVAD-AVR or MVR cohorts.