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10.1016/j.jtcvs.2019.03.089

http://scihub22266oqcxt.onion/10.1016/j.jtcvs.2019.03.089
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suck abstract from ncbi


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pmid31101350      J+Thorac+Cardiovasc+Surg 2020 ; 159 (3): 897-905.e4
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  • Right ventricular function and residual mitral regurgitation after left ventricular assist device implantation determines the incidence of right heart failure #MMPMID31101350
  • Tang PC; Haft JW; Romano MA; Bitar A; Hasan R; Palardy M; Wu X; Aaronson KD; Pagani FD
  • J Thorac Cardiovasc Surg 2020[Mar]; 159 (3): 897-905.e4 PMID31101350show ga
  • BACKGROUND: The effect of significant mitral regurgitation (MR) on outcomes after continuous flow left ventricular assist device (cfLVAD) implantation remains unclear. METHODS: We performed a retrospective review of prospectively collected data from 159 patients with preoperative severe MR who underwent cfLVAD implantation (2003-2017). Two-step cluster analysis using the log-likelihood distance for post-cfLVAD implantation parameters, which included right ventricular (RV) dysfunction, MR severity, and tricuspid regurgitation (TR) severity. Post-cfLVAD implantation echocardiographic parameters were obtained within the first month. RESULTS: Cluster analysis resulted in 3 groups. Group 1 (n = 67) had mild or less MR with moderate-severe RV dysfunction (RVD). Group 2 (n = 43) had moderate-severe MR with moderate-severe RVD. Group 3 (n = 49) had moderate MR with mild RVD. Group 2 had the largest proportion with Interagency Registry for Mechanically Assisted Circulatory Support score of 1 (30.2%) and 2 (41.9%). They were more likely to undergo temporary mechanical circulatory support (18.6%) and tricuspid valve procedure (62.8%). Group 2 had the highest rate of stroke (30.2%; P = .02), hemolysis (39.5%; P = .01), device thrombosis (30%; P = .01), and worst survival (46.5%; P = .01). Survival at 5 years for groups 1, 2, and 3 were 56.0%, 17.6%, and 55.8%. Regression analysis of the entire population showed that greater MR severity after cfLVAD was associated with RV failure (P < .05; odds ratio, 1.6) and RV assist device use (P = .09; odds ratio, 1.6). After excluding tricuspid valve repairs, MR severity had a positive correlation with TR severity (R = 0.33; P < .01). CONCLUSIONS: After cfLVAD implantation, moderate-severe MR and RVD predicted RV failure. Patients with preoperative moderate-severe MR and TR coupled with moderate-severe RVD might benefit the most from mitral and tricuspid valve intervention.
  • |*Heart-Assist Devices[MESH]
  • |*Hemodynamics[MESH]
  • |*Ventricular Function, Left[MESH]
  • |*Ventricular Function, Right[MESH]
  • |Adult[MESH]
  • |Aged[MESH]
  • |Female[MESH]
  • |Heart Failure/diagnostic imaging/*epidemiology/physiopathology[MESH]
  • |Humans[MESH]
  • |Incidence[MESH]
  • |Male[MESH]
  • |Michigan/epidemiology[MESH]
  • |Middle Aged[MESH]
  • |Mitral Valve Insufficiency/diagnostic imaging/epidemiology/physiopathology/*therapy[MESH]
  • |Mitral Valve/diagnostic imaging/*physiopathology[MESH]
  • |Prosthesis Design[MESH]
  • |Prosthesis Implantation/adverse effects/*instrumentation[MESH]
  • |Recovery of Function[MESH]
  • |Registries[MESH]
  • |Retrospective Studies[MESH]
  • |Risk Assessment[MESH]
  • |Risk Factors[MESH]
  • |Time Factors[MESH]
  • |Treatment Outcome[MESH]
  • |Tricuspid Valve Insufficiency/diagnostic imaging/epidemiology/physiopathology[MESH]


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