Key result
Concomitant valvular pathology in destination therapy LVAD patients requires careful management, as aortic insufficiency tends to progress, while routine surgical correction of mitral or tricuspid regurgitation remains controversial.
Why the study?
Uncertainty remains regarding many facets of concomitant valvular pathology and how to best manage these conditions in destination LVAD patients.
This review emphasizes the critical importance of identifying and managing pre-existing and de novo valvular pathology in destination therapy LVAD patients to optimize left ventricular unloading, prevent right ventricular failure, and maximize patient longevity and quality of life.
Answers are grounded in this paper and cite their sources.
Careful valvular management remains essential in DT-LVAD; leaves open whether routine MR/TR correction improves outcomes.
Over the last two decades, implantable continuous flow left ventricular assist devices (LVAD) have proven to be invaluable tools for the management of selected advanced heart failure patients, improving patient longevity and quality of life. The presence of concomitant valvular pathology, including that involving the tricuspid, mitral, and aortic valve, has important implications relating to the decision to move forward with LVAD implantation. Furthermore, the presence of concomitant valvular pathology often influences the surgical strategy for LVAD implantation. Concomitant valve repair or replacement is not uncommonly required in such circumstances, which increases surgical complexity and has demonstrated prognostic implications both short and longer term following LVAD implantation. Beyond the index operation, it is also well established that certain valvular pathologies may develop or worsen over time following LVAD support. The presence of pre-existing valvular pathology or that which develops following LVAD implant is of particular importance to the destination therapy LVAD patient population. As these patients are not expected to have the opportunity for heart transplantation in the future, optimization of LVAD support including ameliorating valvular disease is critical for the maximization of patient longevity and quality of life. As collective experience has grown over time, the ability of clinicians to effectively address concomitant valvular pathology in LVAD patients has improved in the pre-implant, implant, and post-implant phase, through both medical management and procedural optimization. Nevertheless, there remains uncertainty over many facets of concomitant valvular pathology in advanced heart failure patients, and the understanding of how to best approach these conditions in the LVAD patient population continues to evolve. Herein, we present a comprehensive review of the current state of the field relating to the pathophysiology and management of valvular disease in destination LVAD patients.
No takes yet. Share an insight, caveat, or question.
Dimarakis et al. (2022) conducted a review in Valvular disease in patients with destination left ventricular assist devices. Concomitant valvular disease management was evaluated. Concomitant valvular pathology in destination therapy LVAD patients requires careful management, as aortic insufficiency tends to progress, while routine surgical correction of mitral or tricuspid regurgitation remains controversial.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: