Continuous-flow left ventricular assist device implantation in patients with preexisting mechanical mitral valves: a systematic review

ABSTRACT

Introduction: A preexisting mechanical mitral valve (MMV) is thought to be a thrombogenic risk factor after continuous-flow left ventricular assist device (CF-LVAD) implantation. We sought to evaluate the management and outcomes of preexisting MMVs in patients following CF-LVAD implantation.

Areas covered: An electronic search was performed to identify the presence of an MMV at the time of CF-LVAD implantation. Of the 1,168 studies identified, only five studies consisting of seven CF-LVAD patients met the inclusion criteria. Patient-level data were extracted and analyzed.

Expert opinion: The median patient age was 54 (IQR: 42–61) years and 71.4% (5/7) were male. Non-ischemic cardiomyopathy was the predominant etiology (83.3%, 5/6) of heart failure, and bridge-to-transplant the predominant indication (85.7%, 6/7) for CF-LVAD. Aortic valve prosthesis was present in 42.9% (3/7) of patients. Median time from MMV to CF-LVAD placement was 6.0 years (IQR: 1.3–15.0). The median lower limit of the INR range was 2.8 (IQR: 2.1–3.0) and upper limit of the INR range was 3.5 (IQR: 3.1–3.5). During a median follow-up time of 120 (IQR: 70–201) days, there were no major GI bleeds or clinically significant thromboembolic complications. With adequate anticoagulation, preexisting MMVs in CF-LVAD patients did not result in clinically significant thromboembolic events.

KEYWORDS:

• Continuous-flow left ventricular assist device
• mechanical mitral valve
• anticoagulation

Article highlights

• Continuous-Flow Left Ventricular Devices (CF-LVADs) are becoming more common

• Mechanical Mitral Valves (MMVs) are still being used for the treatment of valvular disease

• Interactions between MMVs and CF-LVADs are not well understood

• Anticoagulation needs to be tightly controlled for both MMV patients and CF-LVAD patients

• MMVs can be safely left in patients with CF-LVAD implantation and require strict maintenance of anticoagulation to mitigate complications

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.