Purpose
Mitral regurgitation (MR) is a common issue in Left ventricular assist device (LVAD) patients, yet the impact of LVAD explantation on MR progression remains unclear. This study evaluates MR changes post-explant and identifies predictors of MR worsening.
Methods
A retrospective cohort of 494 patients was analyzed from the VAD Wean Registry with >60 participating sites. MR severity was assessed at baseline, 3 months, 6 months, 1 year, 3 years, and 5 years post-explantation. Patients were categorized into two groups based on whether they experienced MR worsening. Logistic regression was performed to identify predictors of MR worsening.
Results
In the entire cohort, 23% of patients (48 out of 208) who had no MR before explantation showed worsening MR after 5 years, while 4.7% (8 out of 171, p = 0.01) of patients with mild or moderate MR pre-explant experienced progression. Group 1 (no MR worsening) had a mean age of 42.51 ± 16.18 years, while Group 2 (MR worsening) had a mean age of 49.83 ± 5.56 years (p = 0.05). Baseline LVEF was 47.94 ± 10.52% in Group 1 and 50.50 ± 8.69% in Group 2 (p = 0.538). After 5 years, the LVEF remained comparable, with Group 1 having a mean LVEF of 44.56% and Group 2 having a mean LVEF of 41.28% (p = 0.1). Time from LVAD implant to discontinuation was significantly longer in Group 1 (571.89 ± 515.04 days) compared to Group 2 (265.67 ± 136.66 days, p = 0.01). PCWP values were similar between both groups, with no significant differences (p = 0.7), and RV systolic pressure showed no significant variation (p = 0.6). Logistic regression identified age (p = 0.04), LVIDd (p=0.02) and complete explantation technique (p = 0.01) as significant predictors of MR progression.
Conclusion
LVAD explantation leads to MR progression in a notable portion of patients. Older age, LVIDd and complete explantation technique were significant predictors for worsening MR, highlighting the need for careful monitoring post-explantation.
