Key result
Microaxial assist device-associated MR carries ~22% 30-day mortality, higher than AR.
Why the study?
Data regarding valvular complications associated with microaxial hemodynamic support devices are limited, prompting a pooled analysis of incidence, management, and outcomes.
What are the incidence, management, and outcomes of valvular complications related to microaxial assist device use?
Systematic Review (n=27)
What are the incidence, management, and outcomes of valvular complications related to microaxial assist device use?
Microaxial assist devices can cause severe valvular complications, with aortic regurgitation being more common but mitral regurgitation being associated with higher mortality.
Valvular complications after microaxial support require close echocardiographic surveillance and surgical planning; leaves open true incidence and optimal strategies in unselected populations.
BACKGROUND: Microaxial devices provide effective short-term hemodynamic support in patients with cardiogenic shock or during high-risk procedures. However, there is a paucity of data regarding device-associated valvular complications. We sought to pool existing data to understand its incidence, management, and outcomes. METHODS: An electronic search was conducted in October 2024 to identify studies reporting microaxial device-associated valvular complications that did not resolve with device explantation. A total of 26 case reports and case series, representing 27 patients, were included. Patient-level data were extracted for analysis. RESULTS: The median age was 50 years [IQR 34-65], and 78% (21/27) were male. The indications for microaxial support were cardiogenic shock (85.2%, 23/27), coronary bypass grafting (7.4%, 2/27), and high-risk percutaneous coronary intervention (7.4%, 2/27). The most commonly used devices were the Impella 5.0 (41%, 11/27) and Impella CP (22%, 6/27). Aortic regurgitation (AR) developed in 67% of patients (18/27). Mitral regurgitation (MR) developed in 33% (9/27) of patients, all of which were severe. The median duration of microaxial support was 10 [3-15] days. Overall, 74% (20/27) of patients underwent surgical management, 11% (3/27) underwent transcatheter treatment, and 15% (4/27) were managed nonoperatively. In-hospital/30-day mortality was 11% (3/27), including two deaths among patients with MR (22%) and one in a patient with AR (5.6%) with a pre-existing bioprosthetic aortic valve (p = 0.19). When considering the patients with only native valves and excluding the bioprosthetic aortic valve, mortality was significantly higher among MR patients compared to those with AR (MR: 22%; AR: 0%, p = 0.04). At a median follow-up of 183 [30-365] days, overall survival was 89% (24/27). CONCLUSION: AR was more common than MR; however, all MR cases were severe. MR may be associated with worse outcomes. Surgical management appears to be the most frequently employed strategy for valvular injury.
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Hammond et al. (2025) conducted a systematic review in Microaxial device-associated valvular complications (n=27). Microaxial assist device-associated mitral regurgitation vs. Aortic regurgitation was evaluated on In-hospital/30-day mortality among patients with native valves (p=0.04). Microaxial assist device-associated mitral regurgitation resulted in higher in-hospital/30-day mortality compared to aortic regurgitation among patients with native valves (22% vs 0%, p=0.04).
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