Development of postoperative aortic regurgitation in patients undergoing continuous-flow left ventricular assist device implantation

Abstract

Background

This study aimed to investigate the incidence of aortic regurgitation (AR) following continuous-flow left ventricular assist device (LVAD) implantation and to identify associated predisposing factors.

Research Design

The study included 144 patients who underwent LVAD implantation between January 2015 and December 2021. The primary endpoint was defined as the assessment of the development of AR greater than mild. The incidence of and time to AR progression during LVAD therapy, and predisposing factors were evaluated in patients who had none/trivial or mild preoperative AR.

Results

Among the 144 patients included in the study, significant AR developed in 22 patients (15.3%) after a median of 662 days of LVAD support. Multivariate logistic regression analysis revealed that preoperative mild AR (p = 0.002), female sex (p = 0.013), and increased sinus of Valsalva diameter (p = 0.030) were independent predictive factors for AR progression. Persistent aortic valve opening during each cardiac cycle significantly reduced AR progression (p = 0.004). Advanced age (p = 0.009), smaller body surface area (p = 0.018), and elevated systemic vascular resistance (p = 0.045) were significantly associated with AR development.

Conclusion

AR is a frequent complication during LVAD support therapy. Identifying patients at risk for AR progression prior to LVAD implantation is critically important for implementing preventive strategies, early intervention, or effective management of AR.