Persistent Mitral Regurgitation in Turndown Echo Evaluations of by yjg19349


									76. Persistent Mitral Regurgitation in Turndown Echo
Evaluations of LVAD Patients
K. Jane Grande-Allen, Allen G. Borowski, Richard W. Troughton, Michael L. Yeager, Brian P.
Griffin, Mario J. Garcia, Randall C. Starling, Patrick M. McCarthy, James D. Thomas
Cleveland Clinic Foundation, Cleveland, Ohio, United States

OBJECTIVES: Recent findings that left ventricular assist devices (LVADs) can restore
normal ventricular function have stimulated interest in using LVADs as bridges to recovery.
However, it is unclear whether LVADs can reverse the mitral regurgitation (MR) affecting
most heart failure patients. This preliminary study monitored valvular and cardiac dimensions
and function in heart failure patients before and after LVAD insertion and during LVAD
turndown echos.
METHODS: Eight heart failure patients were supported with LVADs for 58±60 days.
Valvular, left ventricular (LV), and left atrial (LA) parameters were measured with TTE before
and after LVAD insertion. Follow up turndown studies reduced the LVAD rate from baseline
by 56±36% during TTE acquisition, based on patients' tolerance to rate changes.
RESULTS: LV and LA dimensions post-LVAD were smaller than pre-LVAD, while ejection
fraction (EF) was improved. Reducing the LVAD rate substantially increased the LV
dimensions and decreased EF (p=0.06), but did not affect the LA. MR was less than pre-
LVAD, but increased during turndown (p=0.06). MR was due to apical tethering, leaflet
thickening, restriction, and redundancy. Duration of LVAD support was not correlated with
any variables in this preliminary group.
CONCLUSIONS: Although cardiac function improved with LVAD therapy, the LV dilatation
partially returned during turndown studies. The MR worsened during turndown, and in 3
patients became as severe as or worse than pre-LVAD levels. These data suggest that LVADs
provide only temporary reversal of valve dysfunction. LVAD bridging to recovery may require
frequent turndown echo monitoring of persistent MR (and orifice/jet area), or surgical repair of
valve dysfunction.

(Data in mean±SD)    Pre-LVAD    Post-LVAD Baseline              LVAD Turned Down
LVEDV, cm3           382±240     178±95                          198±101
LVESV, cm3           324±212     118±67                          156±105
EF, %                15.6±7.0    33.4±9.2                        26.7±13.1
LA Area, cm2         24.5±11.1   17.9±5.5                        16.9±5.3
LA Volume, cm3       86.2±65.1   48.0±21.6                       48.0±21.9
Cardiac Dimenions PreLVAD, Post LVAD, and Turndown

To top