Prevalence, Significance, and Management of Aortic Insufficiency in Continuous Flow Left Ventricular Assist Device Recipients
Background—Aortic insufficiency (AI) is increasingly recognized as a complication of continuous flow left ventricular assist device (CF-LVAD) support; however, its long term prevalence, clinical significance, and efficacy of potential interventions are not well known.
Methods and Results—We studied the prevalence and management of AI in 232 CF-LVAD patients at our institution. Patients with aortic valve (AV) surgery prior to LVAD implantation were excluded from analysis. To examine the prevalence of "de novo" AI, patients without preoperative AI were divided into a retrospective and a prospective cohort based on whether or not a dedicated speed optimization study had been performed at the time of discharge. Forty-three patients underwent AV repair at the time of implant and 3 subsequently developed greater than mild AI. In patients without surgical AV manipulation and no AI at the time of implant, Kaplan-Meier analysis revealed that freedom from greater than mild de novo AI at 1 year was 77.6±4.2%, and that at least moderate AI is expected to develop in 37.6±13.3% after 3 years. Non-opening of the AV was strongly associated with de novo AI development in patients without prospective discharge speed optimization. Seven of 21 patients with at least moderate AI developed symptomatic heart failure requiring surgical intervention.
Conclusions—AI is common in patients with CF-LVADs and may lead to clinical decompensation requiring surgical correction. The prevalence of AI is substantially less in patients whose AV opens, and optimized loading conditions may reduce AI prevalence in those patients in whom AV opening cannot be achieved.
- Received August 17, 2013.
- Accepted January 6, 2014.