Abstract 18562: Severity of Posterior Coaptation Displacement of the Anterior Mitral Leaflet Contributes to Irreversibility of Mitral Regurgitation Following Left Ventricular Assist Device Placement

Abstract

Background The usefulness of concomitant mitral valve surgery at the time of left ventricular assist device (LVAD) placement has not been fully elucidated. We investigated factors associated with irreversibility of mitral regurgitation (MR) after LVAD surgery.

Methods We reviewed 61 consecutive patients undergoing continuous-flow LVAD placement at Columbia University between 2007 and 2010. Echocardiograms within 2 weeks before and 1 week after surgery were analyzed. Irreversibility of MR was defined as the persistence of moderate or severe MR after LVAD placement. We evaluated clinical characteristics and echocardiographic parameters including left ventricular (LV) dimension, left atrial area (LAA), and the mitral leaflet configuration quantified by posterior (D_P) and apical (D_A) displacement of the coaptation point of anterior mitral leaflet (AML). (Figure) The change ([[Unable to Display Character: ⊿]]) of each parameter before and after LVAD placement was also calculated.

Results Fifty-six patients (92.9%) showed a reduction of LV dimension after LVAD placement. Thirty-three patients (54.1%) had moderate to severe MR before surgery. Among those, 5 patients (5/33, 15.2%) underwent concomitant mitral valve repair at the time of LVAD placement, and 19 patients (19/33, 67.9%) showed only mild or less MR due to mechanical unloading by LVAD, but 9 (32.1%) still had at least moderate MR. The [[Unable to Display Character: ⊿]]LV end-diastolic dimension was correlated with [[Unable to Display Character: ⊿]]D_P and [[Unable to Display Character: ⊿]]D_A (r=0.408, p=0.002, r=0.468, p<0.0001, respectively). Pre-operative echo-parameters associated with irreversibility of MR were LV end-diastolic and systolic dimensions, LAA and D_p. Multivariate analysis revealed that only D_p was significantly associated with irreversible MR (HR 1.278, 95%CI 1.015-1.610, p=0.037).

Conclusions Pre-operative echocardiographic severe posterior coaptation displacement of the AML may predict irreversibility of MR following LVAD placement, and could help identify patients that might benefit from MV repair.