Infrequent Need for Temporary Mechanical Circulatory Support After Mitral Valve Surgery

Tomoki Sakata; Yuki Nakamura; Keshava Rajagopal; Vakhtang Tchantchaleishvili; Konstadinos A Plestis; John W Entwistle 3rd; Joseph E Bavaria; Rakesh M Suri

doi:10.1016/j.atssr.2024.09.023

Infrequent Need for Temporary Mechanical Circulatory Support After Mitral Valve Surgery

Ann Thorac Surg Short Rep. 2024 Nov 13;3(1):52-56. doi: 10.1016/j.atssr.2024.09.023. eCollection 2025 Mar.

Authors

Tomoki Sakata¹, Yuki Nakamura¹, Keshava Rajagopal¹, Vakhtang Tchantchaleishvili¹, Konstadinos A Plestis¹, John W Entwistle 3rd¹, Joseph E Bavaria¹, Rakesh M Suri¹

Affiliation

¹ Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.

Abstract

Background: Temporary mechanical circulatory support (tMCS) may be necessary to treat low cardiac output syndrome after mitral valve surgery (MVS) for chronic severe mitral regurgitation (MR). However, prevalence and predictors remain undetermined.

Methods: This single-center retrospective cohort study included 443 patients who underwent primary MVS for degenerative, ischemic, or functional MR between January 2013 and June 2023. Patients requiring tMCS intraoperatively or postoperatively were compared with patients who did not require tMCS. Multivariable logistic regression identified independent risk factors for tMCS requirement.

Results: tMCS was required in 12 of 443 patients (2.7%), with degenerative (2.1%), functional (1.8%), and ischemic (8.3%) MR. Independent risk factors for tMCS requirement were preoperative left ventricular ejection fraction <50% (odds ratio, 4.94; P = .01) and mitral valve replacement (odds ratio, 5.85; P = .005). MR type was not independently influential. The 30-day mortality was 41.7% (5 of 12) in the tMCS group vs 3.5% (15 of 431) in the non-tMCS group (P < .0001).

Conclusions: Requirements for tMCS after MVS for MR are infrequent, but tMCS is associated with high mortality. Low preoperative left ventricular ejection fraction and mitral valve replacement are independent risk factors, thus suggesting that careful surgical planning and meticulous postoperative monitoring are warranted in high-risk cases.