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

Author:

Arjomandi Rad Arian123ORCID,Fleet Ben4ORCID,Zubarevich Alina5ORCID,Nanchahal Sukanya2,Naruka Vinci2ORCID,Subbiah Ponniah Hariharan2ORCID,Vardanyan Robert2ORCID,Sardari Nia Peyman3ORCID,Loubani Mahmoud6ORCID,Moorjani Narain7,Schmack Bastian5ORCID,Punjabi Prakash P.8ORCID,Schmitto Jan5,Ruhparwar Arjang5,Weymann Alexander5

Affiliation:

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

Abstract

AbstractBackgroundThe 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.MethodsA 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.ResultsThe 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.ConclusionBased 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.

Publisher

Wiley

Subject

Biomedical Engineering,General Medicine,Biomaterials,Medicine (miscellaneous),Bioengineering

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