Impact of Residual Mitral Regurgitation on Right Ventricular Systolic Function After Left Ventricular Assist Device Implantation
Significant mitral regurgitation (MR) is thought to decrease after left ventricular assist device (LVAD) implantation, and therefore repair of mitral valve is not indicated in current practice. However, residual moderate and severe MR leads to pulmonary artery pressure increase, thereby resulting in...
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Veröffentlicht in: | Artificial organs 2017-07, Vol.41 (7), p.622-627 |
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description | Significant mitral regurgitation (MR) is thought to decrease after left ventricular assist device (LVAD) implantation, and therefore repair of mitral valve is not indicated in current practice. However, residual moderate and severe MR leads to pulmonary artery pressure increase, thereby resulting in right ventricular (RV) dysfunction during follow‐up. We examined the impact of residual MR on systolic function of the right ventricle by echocardiography after LVAD implantation. This study included 90 patients (mean age: 51.7 ± 10.9 years, 14.4% female) who underwent LVAD implantation (HeartMate II = 21, HeartWare = 69) in a single center between December 2010 and June 2014. Echocardiograms obtained at 3–6 months and over after implantation were analyzed retrospectively. RV systolic function was graded as normal, mild, moderate, and severely depressed. MR (≥moderate) was observed in 43 and 44% of patients at early and late period, respectively. Systolic function of the RV was severely depressed in 16 and 9% of all patients. Initial analysis (mean duration of support 174.3 ± 42.5 days) showed a statistically significant correlation between less MR and improved systolic function of RV (P = 0.01). Secondary echocardiographic analysis (following a mean duration of support of 435.1 ± 203 days) was also statistically significant for MR degree and RV systolic dysfunction (P = 0.008). Residual MR after LVAD implantation may cause deterioration of RV systolic function and cause right‐sided heart failure symptoms. Repair of severe MR, in selected patients such as those with severe pulmonary hypertension and depressed RV, may be considered to improve the patient's clinical course during pump support. |
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However, residual moderate and severe MR leads to pulmonary artery pressure increase, thereby resulting in right ventricular (RV) dysfunction during follow‐up. We examined the impact of residual MR on systolic function of the right ventricle by echocardiography after LVAD implantation. This study included 90 patients (mean age: 51.7 ± 10.9 years, 14.4% female) who underwent LVAD implantation (HeartMate II = 21, HeartWare = 69) in a single center between December 2010 and June 2014. Echocardiograms obtained at 3–6 months and over after implantation were analyzed retrospectively. RV systolic function was graded as normal, mild, moderate, and severely depressed. MR (≥moderate) was observed in 43 and 44% of patients at early and late period, respectively. Systolic function of the RV was severely depressed in 16 and 9% of all patients. Initial analysis (mean duration of support 174.3 ± 42.5 days) showed a statistically significant correlation between less MR and improved systolic function of RV (P = 0.01). Secondary echocardiographic analysis (following a mean duration of support of 435.1 ± 203 days) was also statistically significant for MR degree and RV systolic dysfunction (P = 0.008). Residual MR after LVAD implantation may cause deterioration of RV systolic function and cause right‐sided heart failure symptoms. Repair of severe MR, in selected patients such as those with severe pulmonary hypertension and depressed RV, may be considered to improve the patient's clinical course during pump support.</description><identifier>ISSN: 0160-564X</identifier><identifier>EISSN: 1525-1594</identifier><identifier>DOI: 10.1111/aor.12831</identifier><identifier>PMID: 27873344</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adult ; Doppler effect ; Echocardiography ; Female ; Follow-Up Studies ; Heart diseases ; Heart Ventricles - physiopathology ; Heart Ventricles - surgery ; Heart-Assist Devices - adverse effects ; Humans ; Hypertension ; Implantation ; Left ventricular assist device ; Male ; Middle Aged ; Mitral regurgitation ; Mitral valve ; Mitral Valve Insufficiency - complications ; Mitral Valve Insufficiency - physiopathology ; Mitral Valve Insufficiency - surgery ; Patients ; Pulmonary arteries ; Pulmonary artery ; Regurgitation ; Repair ; Right heart failure ; Statistical analysis ; Statistical significance ; Ventricle ; Ventricular Dysfunction, Right - etiology ; Ventricular Dysfunction, Right - physiopathology ; Ventricular Function, Right</subject><ispartof>Artificial organs, 2017-07, Vol.41 (7), p.622-627</ispartof><rights>2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.</rights><rights>2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4191-5fff391287257ef29695f8fd9f0cdb8aa100be4dc8eaa427d2f9c0be3fa7d19f3</citedby><cites>FETCH-LOGICAL-c4191-5fff391287257ef29695f8fd9f0cdb8aa100be4dc8eaa427d2f9c0be3fa7d19f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faor.12831$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faor.12831$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27873344$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ertugay, Serkan</creatorcontrib><creatorcontrib>Kemal, Hatice S.</creatorcontrib><creatorcontrib>Kahraman, Umit</creatorcontrib><creatorcontrib>Engin, Catagay</creatorcontrib><creatorcontrib>Nalbantgil, Sanem</creatorcontrib><creatorcontrib>Yagdi, Tahir</creatorcontrib><creatorcontrib>Ozbaran, Mustafa</creatorcontrib><title>Impact of Residual Mitral Regurgitation on Right Ventricular Systolic Function After Left Ventricular Assist Device Implantation</title><title>Artificial organs</title><addtitle>Artif Organs</addtitle><description>Significant mitral regurgitation (MR) is thought to decrease after left ventricular assist device (LVAD) implantation, and therefore repair of mitral valve is not indicated in current practice. However, residual moderate and severe MR leads to pulmonary artery pressure increase, thereby resulting in right ventricular (RV) dysfunction during follow‐up. We examined the impact of residual MR on systolic function of the right ventricle by echocardiography after LVAD implantation. This study included 90 patients (mean age: 51.7 ± 10.9 years, 14.4% female) who underwent LVAD implantation (HeartMate II = 21, HeartWare = 69) in a single center between December 2010 and June 2014. Echocardiograms obtained at 3–6 months and over after implantation were analyzed retrospectively. RV systolic function was graded as normal, mild, moderate, and severely depressed. MR (≥moderate) was observed in 43 and 44% of patients at early and late period, respectively. Systolic function of the RV was severely depressed in 16 and 9% of all patients. Initial analysis (mean duration of support 174.3 ± 42.5 days) showed a statistically significant correlation between less MR and improved systolic function of RV (P = 0.01). Secondary echocardiographic analysis (following a mean duration of support of 435.1 ± 203 days) was also statistically significant for MR degree and RV systolic dysfunction (P = 0.008). Residual MR after LVAD implantation may cause deterioration of RV systolic function and cause right‐sided heart failure symptoms. Repair of severe MR, in selected patients such as those with severe pulmonary hypertension and depressed RV, may be considered to improve the patient's clinical course during pump support.</description><subject>Adult</subject><subject>Doppler effect</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart diseases</subject><subject>Heart Ventricles - physiopathology</subject><subject>Heart Ventricles - surgery</subject><subject>Heart-Assist Devices - adverse effects</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Implantation</subject><subject>Left ventricular assist device</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mitral regurgitation</subject><subject>Mitral valve</subject><subject>Mitral Valve Insufficiency - complications</subject><subject>Mitral Valve Insufficiency - physiopathology</subject><subject>Mitral Valve Insufficiency - surgery</subject><subject>Patients</subject><subject>Pulmonary arteries</subject><subject>Pulmonary artery</subject><subject>Regurgitation</subject><subject>Repair</subject><subject>Right heart failure</subject><subject>Statistical analysis</subject><subject>Statistical significance</subject><subject>Ventricle</subject><subject>Ventricular Dysfunction, Right - etiology</subject><subject>Ventricular Dysfunction, Right - physiopathology</subject><subject>Ventricular Function, Right</subject><issn>0160-564X</issn><issn>1525-1594</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kUFLHDEYhoNUulvtwT9QAr3Yw7jJJJmZHBfb1YUVYdXSW8hmvmwjszPbJGPZmz_d6KigYAh8EB6evB8vQkeUnNB0JrrzJzSvGN1DYypykVEh-Sc0JrQgmSj4nxH6EsItIaTkpPiMRnlZlYxxPkb3881Wm4g7i5cQXN3rBl-46NNYwrr3axd1dF2L01269d-If0MbvTN9oz2-2oXYNc7gWd-aJ2xqI3i8APsWnIbgQsQ_4c4ZwOnPRreD-BDtW90E-Po8D9DN7Nf16Xm2uDybn04XmeFU0kxYa5lMS5a5KMHmspDCVraWlph6VWlNCVkBr00FWvO8rHMrTXphVpc1lZYdoOPBu_Xdvx5CVBsXDDQpCHR9ULTiuZCVECyh39-ht13v25ROpSgVY0QURaJ-DJTxXQgerNp6t9F-pyhRj7WoVIt6qiWx356N_WoD9Sv50kMCJgPw3zWw-9ikppfLQfkAkV-ZCA</recordid><startdate>201707</startdate><enddate>201707</enddate><creator>Ertugay, Serkan</creator><creator>Kemal, Hatice S.</creator><creator>Kahraman, Umit</creator><creator>Engin, Catagay</creator><creator>Nalbantgil, Sanem</creator><creator>Yagdi, Tahir</creator><creator>Ozbaran, Mustafa</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>201707</creationdate><title>Impact of Residual Mitral Regurgitation on Right Ventricular Systolic Function After Left Ventricular Assist Device Implantation</title><author>Ertugay, Serkan ; Kemal, Hatice S. ; Kahraman, Umit ; Engin, Catagay ; Nalbantgil, Sanem ; Yagdi, Tahir ; Ozbaran, Mustafa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4191-5fff391287257ef29695f8fd9f0cdb8aa100be4dc8eaa427d2f9c0be3fa7d19f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Doppler effect</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart diseases</topic><topic>Heart Ventricles - physiopathology</topic><topic>Heart Ventricles - surgery</topic><topic>Heart-Assist Devices - adverse effects</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Implantation</topic><topic>Left ventricular assist device</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mitral regurgitation</topic><topic>Mitral valve</topic><topic>Mitral Valve Insufficiency - complications</topic><topic>Mitral Valve Insufficiency - physiopathology</topic><topic>Mitral Valve Insufficiency - surgery</topic><topic>Patients</topic><topic>Pulmonary arteries</topic><topic>Pulmonary artery</topic><topic>Regurgitation</topic><topic>Repair</topic><topic>Right heart failure</topic><topic>Statistical analysis</topic><topic>Statistical significance</topic><topic>Ventricle</topic><topic>Ventricular Dysfunction, Right - etiology</topic><topic>Ventricular Dysfunction, Right - physiopathology</topic><topic>Ventricular Function, Right</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ertugay, Serkan</creatorcontrib><creatorcontrib>Kemal, Hatice S.</creatorcontrib><creatorcontrib>Kahraman, Umit</creatorcontrib><creatorcontrib>Engin, Catagay</creatorcontrib><creatorcontrib>Nalbantgil, Sanem</creatorcontrib><creatorcontrib>Yagdi, Tahir</creatorcontrib><creatorcontrib>Ozbaran, Mustafa</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Artificial organs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ertugay, Serkan</au><au>Kemal, Hatice S.</au><au>Kahraman, Umit</au><au>Engin, Catagay</au><au>Nalbantgil, Sanem</au><au>Yagdi, Tahir</au><au>Ozbaran, Mustafa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Residual Mitral Regurgitation on Right Ventricular Systolic Function After Left Ventricular Assist Device Implantation</atitle><jtitle>Artificial organs</jtitle><addtitle>Artif Organs</addtitle><date>2017-07</date><risdate>2017</risdate><volume>41</volume><issue>7</issue><spage>622</spage><epage>627</epage><pages>622-627</pages><issn>0160-564X</issn><eissn>1525-1594</eissn><abstract>Significant mitral regurgitation (MR) is thought to decrease after left ventricular assist device (LVAD) implantation, and therefore repair of mitral valve is not indicated in current practice. However, residual moderate and severe MR leads to pulmonary artery pressure increase, thereby resulting in right ventricular (RV) dysfunction during follow‐up. We examined the impact of residual MR on systolic function of the right ventricle by echocardiography after LVAD implantation. This study included 90 patients (mean age: 51.7 ± 10.9 years, 14.4% female) who underwent LVAD implantation (HeartMate II = 21, HeartWare = 69) in a single center between December 2010 and June 2014. Echocardiograms obtained at 3–6 months and over after implantation were analyzed retrospectively. RV systolic function was graded as normal, mild, moderate, and severely depressed. MR (≥moderate) was observed in 43 and 44% of patients at early and late period, respectively. Systolic function of the RV was severely depressed in 16 and 9% of all patients. Initial analysis (mean duration of support 174.3 ± 42.5 days) showed a statistically significant correlation between less MR and improved systolic function of RV (P = 0.01). Secondary echocardiographic analysis (following a mean duration of support of 435.1 ± 203 days) was also statistically significant for MR degree and RV systolic dysfunction (P = 0.008). Residual MR after LVAD implantation may cause deterioration of RV systolic function and cause right‐sided heart failure symptoms. Repair of severe MR, in selected patients such as those with severe pulmonary hypertension and depressed RV, may be considered to improve the patient's clinical course during pump support.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>27873344</pmid><doi>10.1111/aor.12831</doi><tpages>6</tpages></addata></record> |
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subjects | Adult Doppler effect Echocardiography Female Follow-Up Studies Heart diseases Heart Ventricles - physiopathology Heart Ventricles - surgery Heart-Assist Devices - adverse effects Humans Hypertension Implantation Left ventricular assist device Male Middle Aged Mitral regurgitation Mitral valve Mitral Valve Insufficiency - complications Mitral Valve Insufficiency - physiopathology Mitral Valve Insufficiency - surgery Patients Pulmonary arteries Pulmonary artery Regurgitation Repair Right heart failure Statistical analysis Statistical significance Ventricle Ventricular Dysfunction, Right - etiology Ventricular Dysfunction, Right - physiopathology Ventricular Function, Right |
title | Impact of Residual Mitral Regurgitation on Right Ventricular Systolic Function After Left Ventricular Assist Device Implantation |
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