AUTHOR=Noly Pierre-Emmanuel , Duggal Neal , Jiang Mulan , Nordsletten David , Bonini Mia , Lei Ienglam , Ela Ashraf Abou El , Haft Jonathan W. , Pagani Francis D. , Cascino Thomas M. , Tang Paul C. TITLE=Role of the mitral valve in left ventricular assist device pathophysiology JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=9 YEAR=2022 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1018295 DOI=10.3389/fcvm.2022.1018295 ISSN=2297-055X ABSTRACT=

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.