[Durable Left Ventricular Assist Device Therapy for Patients with a Prior MitraClip or Impella Intervention].

Abstract

Some patients have undergone implantation of a durable left ventricular assist device( LVAD) following heart failure treatment with Impella( Abiomed) or MitraClip( Abbott). Impella may carry a potential risk of de novo aortic insufficiency (AI), while MitraClip may pose hemodynamic issues under LVAD circulation. In this report, we present the outcomes of durable LVAD therapy in patients with these prior treatments. Seventeen patients had previously received Impella support, and five had undergone MitraClip implantation. Among the 17 post-Impella patients, seven underwent aortic valvuloplasty during LVAD implantation, and one required surgical intervention due to AI progression 10 months postoperatively. Of the nine non-interventional patients, one with moderate AI underwent heart transplantation without intervention five years after the LVAD implantation, while the remaining eight patients had mild or less AI. Four of the five post-MitraClip patients underwent mitral valve replace ment with a bioprosthetic valve during LVAD implantation. The remaining non-interventional patient experienced no hemodynamic problems. The number of LVAD therapies for patients with a prior Impella or MitraClip intervention is expected to increase in the future. It is essential to establish an appropriate therapeutic strategy based on detailed and careful evaluations of individual cases.