Outcomes of Left Ventricular Assist Device Implantation with Mitral Regurgitation with and without Concomitant Mitral Operation

Purpose The clinical impact of mitral valve procedures (MVP) at time of left ventricular assist device (LVAD) is not well understood. We examined the association of MVP, according to severity of MR, with long term survival and quality of life metrics. Methods Continuous-flow LVAD recipients with MR from the 2008-2017 INTERMACS registry were included in the analysis. Patients with concomitant MVP were compared to those without intervention, stratified by severity of MR. Descriptive analyses, hazard modeling, and Kaplan-Meier analyses were used to examine associations between intervention and clinical outcomes. Results 6360 (40.0%) mild, 5592 (35.2%) moderate, and 3936 (24.8%) severe MR cases were included. MVP was not associated with improved survival for mild (median: 80.7 months for MVP vs. 55.0 months for non-MVP, P=0.49, HR 0.65 [95%:0.34-1.23]), moderate (58.8 vs. 49.3 months, P=0.31, HR 0.90 [0.57-1.42]), or severe MR (76.8 vs 49.7 months, P=0.15, HR 1.08 [0.73-1.59]). MVP was not associated with differential risk for device failure, bleeding, arrhythmia, thrombotic, right heart failure, or renal failure. There were no differences in Kansas City Cardiomyopathy Questionnaire with or without MVP for mild, moderate, or severe MR at 1- or 2-years after implantation. Conclusion Concomitant MVP with LVAD implantation was not associated with mortality, adverse events, or objective quality of life metrics. The role of concomitant MVP with LVAD implantation must be carefully considered.