Role of the mitral valve in left ventricular assist device pathophysiology

Pierre-Emmanuel Noly; Neal Duggal; Mulan Jiang; David Nordsletten; Mia Bonini; Ienglam Lei; Ashraf Abou El Ela; Jonathan W. Haft; Francis D. Pagani; Thomas M. Cascino; Paul C. Tang; Paul C. Tang

doi:10.3389/fcvm.2022.1018295

Frontiers in Cardiovascular Medicine (Oct 2022)

Role of the mitral valve in left ventricular assist device pathophysiology

Pierre-Emmanuel Noly,
Neal Duggal,
Mulan Jiang,
David Nordsletten,
Mia Bonini,
Ienglam Lei,
Ashraf Abou El Ela,
Jonathan W. Haft,
Francis D. Pagani,
Thomas M. Cascino,
Paul C. Tang,
Paul C. Tang

Affiliations

Pierre-Emmanuel Noly: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
Neal Duggal: Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
Mulan Jiang: Massachusetts Institute of Technology, Cambridge, MA, United States
David Nordsletten: Department of Biomedical Engineering and Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
Mia Bonini: Department of Biomedical Engineering and Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
Ienglam Lei: Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States
Ashraf Abou El Ela: Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States
Jonathan W. Haft: Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States
Francis D. Pagani: Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States
Thomas M. Cascino: Division of Cardiovascular Medicine, Department of Internal Medicine, School of Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
Paul C. Tang: Department of Biomedical Engineering and Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
Paul C. Tang: Department of Cardiac Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, United States

DOI: https://doi.org/10.3389/fcvm.2022.1018295
Journal volume & issue: Vol. 9

Abstract

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Functional mitral regurgitation (MR) in the setting of heart failure results from progressive dilatation of the left ventricle (LV) and mitral annulus. This leads to leaflet tethering with posterior displacement. Contrary to common assumptions, MR often does not resolve with LVAD decompression of the LV alone. The negative impact of significant (moderate-severe) mitral regurgitation in the LVAD setting is becoming better recognized in terms of its harmful effect on right heart function, pulmonary vascular resistance and hospital readmissions. However, controversies remain regarding the threshold for intervention and management. At present, there are no consensus indications for the repair of significant mitral regurgitation at the time of LVAD implantation due to the conflicting data regarding potential adverse effects of MR on clinical outcomes. In this review, we summarize the current understanding of MR pathophysiology in patients supported with LVAD and potential future management strategies.

Published in Frontiers in Cardiovascular Medicine

ISSN: 2297-055X (Online)
Publisher: Frontiers Media S.A.
Country of publisher: Switzerland
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.frontiersin.org/journals/cardiovascular-medicine

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