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.

中文翻译：

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左心室辅助装置植入对二尖瓣反流的影响：MOMENTUM 3试验的分析。

背景

二尖瓣关闭不全（MR）决定了晚期心力衰竭的病理生理和预后。左心室辅助装置（LVAD）的放置对临床意义上的MR及其对长期结局的贡献的影响已得到稀疏评估。

方法

我们评估了在MOMENTUM 3试验中植入有HeartMate II（HMII）或HeartMate 3（HM3）的MOMENTUM 3试验中有临床意义的MR在2年时的效果。临床意义定义为通过基于部位的超声心动图确定的中度或重度MR。

结果

在927例未进行过或未进行二尖瓣手术的LVAD植入患者中，有403名（43.5％）在基线时具有临床上显着的MR。在支持的1个月时，残留MR出现在6.2％的HM3患者和14.3％的HMII患者中（相对危险度= 0.43； 95％CI为0.22-0.84；p  = 0.01），且恶化率较低。 2年。HM3（危险比[HR]，1.41； 95％CI，0.52–3.89；p  = 0.50）或HMII（HR，0.91； 95％），植入后1个月的残留MR均不影响2年死亡率。CI，0.37–2.26；p  = 0.84）LVAD。基线MR的存在与否均不影响死亡率（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），重大不良事件或功能能力。在多变量分析中，严重的基线MR（p  = 0.001），较大的左心室尺寸（p  = 0.002）以及用HMII而不是HM3 LVAD植入（p  = 0.05）与增加的持续MR可能性相关。注入。

结论

LVAD植入后的血流动力学卸荷可在HM3 LVAD的早期，持续性和更大程度上改善具有临床意义的MR。LVAD植入后，基线和残留MR均不影响预后。