Concomitant valve procedures in patients undergoing continuous-flow left ventricular assist device implantation: A single-center experience

J Thorac Cardiovasc Surg. 2019 Oct;158(4):1083-1089.e1. doi: 10.1016/j.jtcvs.2019.02.040. Epub 2019 Feb 21.


Objective: Long-term support with continuous-flow left ventricular assist devices (CF-LVADs) has improved the outcomes of patients with end-stage heart failure. However, valve disease management in patients who undergo CF-LVAD implantation remains controversial. The aim of this study was to assess our single-center experience with patients who underwent a concomitant valve procedure during implantation of a CF-LVAD.

Methods: From November 2003 through March 2016, 526 patients underwent primary CF-LVAD implantation with a HeartMate II (St Jude Inc, St Paul, Minn; n = 403) or HeartWare (Medtronic, Minneapolis, Minn; n = 123) device at our center. Of those, 91 underwent a concomitant valve procedure during implantation (CF-LVAD+valve procedure group), whereas 435 did not (CF-LVAD-only group). We compared preoperative characteristics and short-term and mid-term survival rates between these groups.

Results: The concomitant valve procedures performed included 13 tricuspid valve repairs, 19 aortic valve repairs or replacements, 30 mitral valve repairs or replacements, and 29 double valve repairs or replacements. Survival rates at 1 month, 6 months, 12 months, and 24 months were 90.3%, 81.4%, 74.9%, and 67.4%, respectively, for the CF-LVAD-only group and 89.0%, 75.8%, 70.3%, and 65.9%, respectively, for the CF-LVAD+valve procedure group (P = .55). The results of Cox regression multivariable modeling showed that performing a concomitant valve procedure was not an independent predictor of mortality (hazard ratio, 1.29; 95% confidence interval, 0.96-1.74; P = .08).

Conclusions: In our experience, performing a concomitant valve procedure during CF-LVAD implantation was not associated with an increased mortality rate. The decision to perform a concomitant valve procedure should be made primarily on the basis of clinical indications for the procedure.

Keywords: concomitant valve procedures; heart failure; left ventricular assist device; valve disease.

Publication types

  • Video-Audio Media

MeSH terms

  • Heart Failure / diagnostic imaging
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Heart Valve Diseases / diagnostic imaging
  • Heart Valve Diseases / mortality
  • Heart Valve Diseases / physiopathology
  • Heart Valve Diseases / surgery*
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis Implantation* / instrumentation
  • Heart Valve Prosthesis Implantation* / mortality
  • Heart Valves / diagnostic imaging
  • Heart Valves / physiopathology
  • Heart Valves / surgery*
  • Heart-Assist Devices*
  • Hemodynamics*
  • Humans
  • Mitral Valve Annuloplasty* / adverse effects
  • Mitral Valve Annuloplasty* / instrumentation
  • Mitral Valve Annuloplasty* / mortality
  • Recovery of Function
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Texas
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left*