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

• Published in: Artificial organs 2024-01, Vol.48 (1), p.16-27
• Main Authors: Arjomandi Rad, Arian, Fleet, Ben, Zubarevich, Alina, Nanchahal, Sukanya, Naruka, Vinci, Subbiah Ponniah, Hariharan, Vardanyan, Robert, Sardari Nia, Peyman, Loubani, Mahmoud, Moorjani, Narain, Schmack, Bastian, Punjabi, Prakash P., Schmitto, Jan, Ruhparwar, Arjang, Weymann, Alexander
• Format: Article
• Language: English
• Subjects: Bleeding; Decision making; Heart; Implantation; Lesions; LVAD; mechanical circulatory support; Meta-analysis; Mitral valve; mitral valve surgery; Mortality; Patients; Postoperative period; Regurgitation; Renal function; Surgery; Systematic review; Ventricle; Ventricular assist devices
• ISSN: 0160-564X; 1525-1594
• DOI: 10.1111/aor.14659

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. Concomitant MV surgery during LVAD implantation did not significantly affect overall mortality or other clinical outcomes. Decision‐making regarding MV surgery should be individualized, considering patient‐specific factors and characteristics.