Left ventricular assist device implantation and concomitant mitral valve surgery: A systematic review and meta-analysis

Arian Arjomandi Rad; Ben Fleet; Alina Zubarevich; Sukanya Nanchahal; Vinci Naruka; Hariharan Subbiah Ponniah; Robert Vardanyan; Peyman Sardari Nia; Mahmoud Loubani; Narain Moorjani; Bastian Schmack; Prakash P Punjabi; Jan Schmitto; Arjang Ruhparwar; Alexander Weymann

doi:10.1111/aor.14659

Left ventricular assist device implantation and concomitant mitral valve surgery: A systematic review and meta-analysis

Artif Organs. 2024 Jan;48(1):16-27. doi: 10.1111/aor.14659. Epub 2023 Oct 12.

Authors

Arian Arjomandi Rad^{1

2

3}, Ben Fleet⁴, Alina Zubarevich⁵, Sukanya Nanchahal², Vinci Naruka², Hariharan Subbiah Ponniah², Robert Vardanyan², Peyman Sardari Nia³, Mahmoud Loubani⁶, Narain Moorjani⁷, Bastian Schmack⁵, Prakash P Punjabi⁸, Jan Schmitto⁵, Arjang Ruhparwar⁵, Alexander Weymann⁵

Affiliations

¹ Medical Sciences Division, University of Oxford, Oxford, UK.
² Department of Surgery and Cancer, Imperial College London, London, UK.
³ Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.
⁴ School of Medicine, Lancaster University, Lancaster, UK.
⁵ Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
⁶ Department of Cardiothoracic Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK.
⁷ Department of Cardiothoracic Surgery, Royal Papworth NHS Trust, Cambridge, UK.
⁸ Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, London, UK.

PMID: 37822301
DOI: 10.1111/aor.14659

Abstract

Background: The management of concomitant valvular lesions in patients undergoing left ventricular assist device (LVAD) implantation remains a topic of debate. This systematic review and meta-analysis aimed to evaluate the existing evidence on postoperative outcomes following LVAD implantation, with and without concomitant MV surgery.

Methods: A systematic database search was conducted as per PRISMA guidelines, of original articles comparing LVAD alone to LVAD plus concomitant MV surgery up to February 2023. The primary outcomes assessed were overall mortality and early mortality, while secondary outcomes included stroke, need for right ventricular assist device (RVAD) implantation, postoperative mitral valve regurgitation, major bleeding, and renal dysfunction.

Results: The meta-analysis included 10 studies comprising 32 184 patients. It revealed that concomitant MV surgery during LVAD implantation did not significantly affect overall mortality (OR:0.83; 95% CI: 0.53 to 1.29; p = 0.40), early mortality (OR:1.17; 95% CI: 0.63 to 2.17; p = 0.63), stroke, need for RVAD implantation, postoperative mitral valve regurgitation, major bleeding, or renal dysfunction. These findings suggest that concomitant MV surgery appears not to confer additional benefits in terms of these clinical outcomes.

Conclusion: Based on the available evidence, concomitant MV surgery during LVAD implantation does not appear to have a significant impact on postoperative outcomes. However, decision-making regarding MV surgery should be individualized, considering patient-specific factors and characteristics. Further research with prospective studies focusing on specific patient populations and newer LVAD devices is warranted to provide more robust evidence and guide clinical practice in the management of valvular lesions in LVAD recipients.

Keywords: LVAD; mechanical circulatory support; mitral valve; mitral valve surgery.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Heart Failure*
Heart-Assist Devices* / adverse effects
Hemorrhage / complications
Humans
Kidney Diseases* / complications
Mitral Valve / surgery
Mitral Valve Insufficiency* / complications
Mitral Valve Insufficiency* / surgery
Prospective Studies
Retrospective Studies
Stroke*
Treatment Outcome