LAUSR

OBJECTIVES Optimal management of significant mitral regurgitation (SMR) during left ventricular assist device (LVAD) placement remains uncertain. This study evaluates the effect of untreated pre-op SMR on outcomes following LVAD implant. METHODS Adults undergoing primary LVAD placement from April 2004 to May 2017 were included. Most recent pre-op transthoracic echocardiogram (TTE) was used to divide patients into an SMR group with moderate or greater regurgitation, and a group without SMR. Patients underwent LVAD implant without correction of SMR. Primary endpoint was 3-year post-operative survival, with secondary endpoints of length of stay (LOS), resolution of SMR following LVAD on post-discharge (30 day) TTE, and 1-year TTE. RESULTS LVAD placement was performed in 270 patients, 172 (63.7%) without SMR and 98 (36.3 %) with SMR. There were no differences in co-morbidities including diabetes, hypertension, and renal disease. Pre-op ejection fraction was similar, but a higher pulmonary vascular resistance was recorded in the SMR group (3.6 vs 3.0 Wood Units, p=0.048). There was no difference in 3-year mortality between the 2 cohorts (log-rank p=0.0.803). The SMR group had decreased LOS (median 19.5 vs 22 days, p=0.009). Of the 98 SMR patients, 91 (92.9 %) had resolution of SMR to less than moderate at 30 days. At 1 year, 15% of those with pre-operative SMR had recurrent SMR. CONCLUSIONS Patients undergoing LVAD placement with pre-op SMR experience no differences in mortality, and a majority experience resolution of MR after implant. Longer-term SMR recurrence and need for mitral intervention with LVAD implant warrant further investigation.