(594) - Aortic Valve Interventions: Durability and Morbidity in Patients on Continuous Flow LVAD Support

Abstract

Aortic valve repair or replacement (AVR) may reduce AI development after continuous flow (CF) LVAD implant and theoretically could reduce the risk of recurrent heart failure after LVAD, especially in those for whom long term support is anticipated. The aim herein is to evaluate the durability and morbidity associated with aortic valve (AV) interventions in CFLVAD patients. A retrospective, multicenter, analysis of CFLVAD patients with AV interventions was conducted. Kaplan-Meier estimates of survival were calculated. Cumulative frequencies of gastrointestinal bleeds (GIB), peripheral embolism, and VAD thrombosis were tallied. Severity of AI at last follow-up echocardiogram was measured. Of the 37 patients studied, 35 underwent AV intervention at the time of CFLVAD implant and 2 had preexisting bioprosthetic AVR left unadultered. Median [25th, 75th] patient age was 61 [53,68] years and 51% were supported for destination therapy. Operative AV interventions at the time of VAD included 24 (65%) AV repairs, 7 bioprosthetic AVRs (19%), and 4 AV occlusions (11%) for prior mechanical AVRs. Over a median 304 (mean 510) days of patient support, there were 14 deaths with 1 and 2 year survivals of 71±8.5% and 58±11%. Freedom from VAD hemolysis at 1 year was 90±5.8% with an overall event rate of 0.17 per patient-year (PPY) of support. GIB and peripheral embolism occurred at events rates of 0.21 PPY and 0.12 PPY, respectively. Echocardiograms performed a median 306 [147,703] days after VAD implant showed the presence of mild-moderate AI in 1 patient and <= mild AI in the remaining patients. AV interventions are a durable means of reducing postLVAD AI. The requirement for AV intervention is associated with lower survival and increased device thrombosis. The benefits of VAD therapy in patients requiring AV intervention should be weighed against the increased risks associated with AV interventions.