51
|
Bhama JK. Commentary: A tale of two valves. J Thorac Cardiovasc Surg 2019; 159:908-909. [PMID: 31256968 DOI: 10.1016/j.jtcvs.2019.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jay K Bhama
- Department of Cardiothoracic Surgery, Baptist Heart Failure and Transplant Institute, Baptist Health Medical Center, Little Rock, Ark.
| |
Collapse
|
52
|
Bechtel JFM. Commentary: When suction alone is not enough. J Thorac Cardiovasc Surg 2019; 159:906-907. [PMID: 31128905 DOI: 10.1016/j.jtcvs.2019.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 10/26/2022]
Affiliation(s)
- J F Matthias Bechtel
- Department for Cardiothoracic Surgery, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
| |
Collapse
|
53
|
Cluster analysis of preoperative echocardiographic findings and outcomes following left ventricular device implantation. J Thorac Cardiovasc Surg 2019; 157:1851-1860.e1. [DOI: 10.1016/j.jtcvs.2018.11.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/23/2018] [Accepted: 11/14/2018] [Indexed: 11/22/2022]
|
54
|
Commentary: Mitral valve repair with left ventricular assist device implantation: Yes! But who? J Thorac Cardiovasc Surg 2019; 157:1849-1850. [DOI: 10.1016/j.jtcvs.2018.12.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 10/27/2022]
|
55
|
Practical valvular issues in patients requiring ventricular assist devices. Curr Opin Cardiol 2019; 33:162-167. [PMID: 29334508 DOI: 10.1097/hco.0000000000000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW As ventricular assist device (VAD) therapy in patients with advanced heart failure continues to grow, experience with concomitant valvular diseases present either before or after VAD implantation continues to accrue. In this review, we discuss recent data and current practice as it pertains to the subject of concomitant valvular disease in patients requiring VADs. RECENT FINDINGS Persistent aortic valve closure has been identified as a potential contributor to aortic valve 'disuse atrophy' resulting in valve degeneration. Dilation of the aortic root may be predictive of future development of aortic insufficiency. Novel echocardiographic parameters to identify the severity of aortic insufficiency following VAD implantation may be useful for risk stratification. Concomitant repair of significant mitral regurgitation may confer benefit to pulmonary vascular resistance and right ventricular function; however, this remains controversial. Concomitant repair of significant tricuspid regurgitation has not demonstrated early postoperative benefit nor survival benefit. Atrial fibrillation has emerged as a risk factor that may predict accelerated progression of postoperative tricuspid regurgitation. SUMMARY Management of aortic insufficiency, mitral regurgitation or tricuspid regurgitation in patients requiring VADs continues to be the source of controversy. As experience accrues with varying strategies to prevent or manage these valvular lesions, our understanding of the impact of these strategies continues to evolve.
Collapse
|
56
|
Kalavrouziotis D, Dagenais F. Commentary: Concomitant valve surgery during left ventricular assist device implantation is risk free: Is God in the details or is it the devil? J Thorac Cardiovasc Surg 2019; 158:1092-1093. [PMID: 30935676 DOI: 10.1016/j.jtcvs.2019.02.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Dimitri Kalavrouziotis
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Francois Dagenais
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
| |
Collapse
|
57
|
Deshmukh A, Bhatia A, Sayer GT, Kim G, Raikhelkar J, Imamura T, Ozcan C, Ota T, Jeevanandam V, Uriel N. Left Atrial Appendage Occlusion With Left Ventricular Assist Device Decreases Thromboembolic Events. Ann Thorac Surg 2019; 107:1181-1186. [DOI: 10.1016/j.athoracsur.2018.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/30/2018] [Accepted: 09/05/2018] [Indexed: 02/06/2023]
|
58
|
Okoh A, Yanagida R, Schultheis M, Chaudari S, Fugar S, Nnaoma C, Chan O, Zucker M, Karanam R, Russo M, Camacho M. Impact of Baseline Mitral Regurgitation on Postoperative Outcomes After Left Ventricular Assist Device Implantation as Destination Therapy. Transplant Proc 2019; 51:859-864. [DOI: 10.1016/j.transproceed.2019.01.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/08/2018] [Accepted: 01/17/2019] [Indexed: 01/07/2023]
|
59
|
Ammirati E, Van De Heyning CM, Musca F, Brambatti M, Perna E, Cipriani M, Cannata A, Mondino M, Moreo A, De Bock D, Pretorius V, Claeys MJ, Adler ED, Russo CF, Frigerio M. Safety of centrifugal left ventricular assist device in patients previously treated with MitraClip system. Int J Cardiol 2019; 283:131-133. [PMID: 30833105 DOI: 10.1016/j.ijcard.2019.02.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/14/2019] [Accepted: 02/18/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION No data regarding the safety of continuous-flow left ventricular assist device (CF-LVAD) implantation in patients with previous MitraClip have been reported. Thus, it remains unknown whether an initial treatment strategy with MitraClip therapy might complicate future heart failure management in patients who are also considered for CF-LVAD. METHODS We retrospectively identified 6 patients (median age of 62 years; 2 women) who had been treated with MitraClip, that were eventually implanted with a CF-LVAD (all Heartware HVAD) in 3 hospitals between 2013 and 2018. RESULTS Patients were treated in 4 cases with 2 clips, and in 2 cases with 1 clip. Median time from MitraClip implantation to CF-LVAD implant was 282 days (interquartile range 67 to 493), and median time on CF-LVAD support was 401 days (interquartile range 105 to 492 days). Two patients underwent a heart transplant, 3 patients died on support, and 1 is alive on support. In all cases, there was a reduction of functional mitral regurgitation without MitraClip-related complications. CONCLUSIONS Based on this small case series, implantation of a CF-LVAD appears safe in patients with a previously positioned MitraClip system, at least, with 1 or 2 clips in place, with no need for additional mitral valve surgery.
Collapse
Affiliation(s)
| | | | | | - Michela Brambatti
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Enrico Perna
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | | | - Aldo Cannata
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | | | | | - Dina De Bock
- Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Victor Pretorius
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Eric D Adler
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Maria Frigerio
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| |
Collapse
|
60
|
Pawale A, Itagaki S, Parikh A, Pinney SP, Adams DH, Anyanwu AC. Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation. J Thorac Cardiovasc Surg 2018; 157:1841-1848.e1. [PMID: 31288361 DOI: 10.1016/j.jtcvs.2018.12.071] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 11/21/2018] [Accepted: 12/10/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The management of severe mitral regurgitation (MR) at the time of left ventricular assist device (LVAD) implantation is controversial. We adopted an approach of systematic repair of severe MR at the time of LVAD implantation and report our experience. METHODS We performed mitral valve repair (MVr) on 78 consecutive patients with severe MR undergoing LVAD implantation at our institution between 2013 and 2017. We compared data on these patients to 28 historical controls with severe MR from the immediate preceding period between 2011 and 2013 where the MR was not treated, using Cox modeling and propensity score methods. Median follow-up time was 17.7 months. RESULTS Patients who underwent MVr were younger than those who did not (non-MVr group) (55 vs 63 years; P = .006), but otherwise had similar preoperative characteristics. The incidence of 30-day mortality (2.6% vs 3.6%; P = .78) and other early major adverse events was similar in both groups. At 3 months, no patient in the MVr group had more than mild MR compared with 7 patients (29%) in the non-MVr group (P < .001). Cardiac catheterization done 3 to 6 months after surgery showed tendency toward greater reduction from preoperative pulmonary artery systolic pressure in the MVr group compared with the non-MVr group (-20 vs -13 mm Hg; P = .10). The cumulative incidence of readmission due to congestive heart failure at 2 years was lower in the MVr group than in non-MVr group (7.1% vs 19.7%; adjusted hazard ratio, 0.18; 95% confidence interval, 0.04-0.76; P = .02). CONCLUSIONS Concurrent MVr at the time of LVAD implantation can be done safely without increase in perioperative adverse events. MVr may be associated with better reduction in severity of MR and may have potential benefit in terms of reduction in readmissions for heart failure.
Collapse
Affiliation(s)
- Amit Pawale
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shinobu Itagaki
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Aditya Parikh
- Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sean P Pinney
- Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David H Adams
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anelechi C Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
| |
Collapse
|
61
|
|
62
|
Abstract
Surgical maneuvers for implantation of a continuous-flow ventricular assist device are revolutionary concepts that have been associated with a reduction in pump-related complications. With the advancement of technology, surgical implant strategy continues to evolve, incorporating less-invasive approaches into the armamentarium of the experienced surgeon.
Collapse
Affiliation(s)
- Colleen Pietras
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Silverstein, Philadelphia, PA 19104, USA
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Silverstein, Philadelphia, PA 19104, USA.
| |
Collapse
|
63
|
Maxwell C, Whitener G. Mitral Intervention with LVAD: Preparing for Recovery. Semin Cardiothorac Vasc Anesth 2018; 23:134-139. [PMID: 30014773 DOI: 10.1177/1089253218788081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Left ventricular assist device (LVAD) insertion is an increasingly common treatment of advanced heart failure. Insertion guidelines suggest regurgitant lesions of the mitral valve should not be addressed. However, recent evidence suggests that mitral regurgitation may not necessarily improve with LVAD insertion, and such patients may have worse outcomes. Thus, practice variability is high given the discrepancy between traditional thinking and new evidence that unrepaired mitral regurgitation may increase perioperative mortality. Additionally, the challenges of LVADs can make transesophageal echocardiography evaluation and assessment of mitral valve pathology difficult.
Collapse
|