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.
SavareseGBecherPMLundLH, et al.Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res2023; 118: 3272–3287.
2.
KirklinJKNaftelDCPaganiFD, et al.Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant2015; 34: 1495–1504.
3.
TrubyLKGaranARGivensRC, et al.Aortic insufficiency during contemporary left ventricular assist device support: analysis of the INTERMACS Registry. JACC Heart Fail2018; 6: 951–960.
4.
BouabdallaouiNEl-HamamsyIPhamM, et al.Aortic regurgitation in patients with a left ventricular assist device: A contemporary review. J Heart Lung Transplant2018; 37: 1289–1297.
5.
GasparovicHKopjarTSaeedD, et al.De Novo Aortic Regurgitation After Continuous-Flow Left Ventricular Assist Device Implantation. Ann Thorac Surg2017; 104: 704–711.
6.
DeoSVSharmaVChoYH, et al.De novo aortic insufficiency during long-term support on a left ventricular assist device: a systematic review and meta-analysis. ASAIO J2014; 60: 183–188.
7.
SoleimaniBHaouziAManoskeyA, et al.Development of Aortic Insufficiency in Patients Supported With Continuous Flow Left Ventricular Assist Devices. ASAIO J2012; 58: 326–329.
8.
JohnRMantzKEckmanP, et al.Aortic valve pathophysiology during left ventricular assist device support. J Heart Lung Transplant2010; 29: 1321–1329.
9.
RoseAGParkSJBankAJ, et al.Partial aortic valve fusion induced by left ventricular assist device. Ann Thorac Surg2000; 70: 1270–1274.
10.
ConnellyJHAbramsJKlimaT, et al.Acquired commissural fusion of aortic valves in patients with left ventricular assist devices. J Heart Lung Transplant2003; 22: 1291–1295.
11.
MuddJOCudaJDHalushkaM, et al.Fusion of Aortic Valve Commissures in Patients Supported by a Continuous Axial Flow Left Ventricular Assist Device. J Heart Lung Transplant2008; 27: 1269–1274.
12.
May-NewmanKHillenBDembitskyW. Effect of Left Ventricular Assist Device Outflow Conduit Anastomosis Location on Flow Patterns in the Native Aorta. ASAIO J2006; 52: 132–139.
13.
CowgerJRaoVMasseyT, et al.Comprehensive review and suggested strategies for the detection and management of aortic insufficiency in patients with a continuous-flow left ventricular assist device. J Heart Lung Transplant2015; 34: 149–157.
14.
da Rocha e SilvaJGMeyerALEifertS, et al.Influence of aortic valve opening in patients with aortic insufficiency after left ventricular assist device implantation. Eur J Cardio Thorac Surg2016; 49: 784–787.
15.
KagawaHAranda-MichelEKormosRL, et al.Aortic Insufficiency After Left Ventricular Assist Device Implantation: Predictors and Outcomes. Ann Thorac Surg2020; 110: 836–843.
16.
HolleyCTFitzpatrickMRoySS, et al.Aortic insufficiency in continuous-flow left ventricular assist device support patients is common but does not impact long-term mortality. J Heart Lung Transplant2017; 36: 91–96.
17.
AggarwalARaghuvirREryaziciP, et al.The Development of Aortic Insufficiency in Continuous-Flow Left Ventricular Assist Device–Supported Patients. Ann Thorac Surg2013; 95: 493–498.
18.
PatilNPMohitePNSabashnikovA, et al.Does postoperative blood pressure influence development of aortic regurgitation following continuous-flow left ventricular assist device implantation?Eur J Cardio Thorac Surg2016; 49: 788–794.
19.
HiraokaACohenJEShudoY, et al.Evaluation of late aortic insufficiency with continuous flow left ventricular assist device. Eur J Cardio Thorac Surg2015; 48: 400–406.
20.
JordeUPKushwahaSSTatoolesAJ, et al.Results of the Destination Therapy Post-Food and Drug Administration Approval Study With a Continuous Flow Left Ventricular Assist Device. J Am Coll Cardiol2014; 63: 1751–1757.
21.
HatanoMKinugawaKShigaT, et al.Less Frequent Opening of the Aortic Valve and a Continuous Flow Pump Are Risk Factors for Postoperative Onset of Aortic Insufficiency in Patients With a Left Ventricular Assist Device. Circ J2011; 75: 1147–1155.
22.
BhagraSBhagraCÖzalpF, et al.Development of de novo aortic valve incompetence in patients with the continuous-flow HeartWare ventricular assist device. J Heart Lung Transplant2016; 35: 312–319.
23.
CowgerJPaganiFDHaftJW, et al.The development of aortic insufficiency in left ventricular assist device-supported patients. Circ Heart Fail2010; 3: 668–674.
24.
MehraMRClevelandJCJrUrielN, et al.Primary results of long-term outcomes in the MOMENTUM 3 pivotal trial and continued access protocol study phase: a study of 2200 HeartMate 3 left ventricular assist device implants. Eur J Heart Fail2021; 23: 1392–1400.
25.
GoldsteinDJNakaYHorstmanshofD, et al.Association of Clinical Outcomes With Left Ventricular Assist Device Use by Bridge to Transplant or Destination Therapy Intent: The Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 (MOMENTUM 3) Randomized Clinical Trial. JAMA Cardiol2020; 5: 411–419.
26.
RajagopalKDaneshmandMAPatelCB, et al.Natural history and clinical effect of aortic valve regurgitation after left ventricular assist device implantation. J Thorac Cardiovasc Surg2013; 145: 1373–1379.
27.
PakSWUrielNTakayamaH, et al.Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices. J Heart Lung Transplant2010; 29: 1172–1176.
28.
MalickANingYKurlanskyPA, et al.Development of De Novo Aortic Insufficiency in Patients With HeartMate 3. Ann Thorac Surg2022; 114: 450–456.
29.
TanakaYNakajimaTFischerI, et al.The impact of uncorrected mild aortic insufficiency at the time of left ventricular assist device implantation. J Thorac Cardiovasc Surg2020; 160: 1490–1500.
30.
CowgerJAAaronsonKDRomanoMA, et al.Consequences of aortic insufficiency during long-term axial continuous-flow left ventricular assist device support. J Heart Lung Transplant2014; 33: 1233–1240.
31.
WenzelJPPetersenENikorowitschJ, et al.Aortic root dimensions as a correlate for aortic regurgitation’s severity. Int J Cardiovasc Imaging2021; 37: 3439–3449.
