Key result
Preexisting mechanical mitral valves in anticoagulated CF-LVAD patients result in 0 major thromboembolic or GI bleeds.
Why the study?
Preexisting mechanical mitral valves are thought to be a thrombogenic risk factor following CF-LVAD implantation, prompting evaluation of their management and outcomes.
Does CF-LVAD implantation in patients with preexisting mechanical mitral valves result in clinically significant thromboembolic events?
Systematic Review (n=7)
Does CF-LVAD implantation in patients with preexisting mechanical mitral valves result in clinically significant thromboembolic events?
With adequate anticoagulation, preexisting mechanical mitral valves in CF-LVAD patients do not appear to result in clinically significant thromboembolic events, though data is extremely limited.
Supports retaining preexisting MMVs with strict anticoagulation in CF-LVAD patients; limited data leave open need for larger studies.
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.
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Gordon et al. (2020) conducted a systematic review in Heart failure requiring CF-LVAD with preexisting mechanical mitral valve (n=7). CF-LVAD implantation with preexisting mechanical mitral valve was evaluated on Major GI bleeds or clinically significant thromboembolic complications. With adequate anticoagulation, preexisting mechanical mitral valves in CF-LVAD patients did not result in clinically significant thromboembolic events or major GI bleeds (0 events in 7 patients).
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