Acquired Aortic Insufficiency with 2nd Versus 3rd Generation Continuous Flow Left Ventricular Assist Device

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Purpose Aortic insufficiency (AI) in patients with continuous flow left ventricular assist devices (LVADs) is detrimental to LVAD function, functional capacity, and mortality. There is increasing evidence of acquired AI after implantation of 2nd generation LVADs. We compare the incidence of acquired AI in patients implanted with 2nd versus 3rd generation LVADs. Methods and Materials Sixty four patients implanted with LVADs from 2008-2012 and supported for at least six months were included. There were 46 patients (72%) with 2nd generation (axial flow) LVAD – Group A, and 18 patients (28%) with 3rd generation (centrifugal flow) LVAD – Group B. Echocardiograhic data was compared between groups at baseline, 6, 12 and 18 months. Results Baseline characteristics were similar between groups. Average support time was 19.8±9.5 and 21.9±10.6 months for Group A and Group B, respectively (p=0.43). Pre-implant LVEDD and LVESD for Group A and Group B were: 7.0±1.2 cm and 6.8±1.1 cm (p=0.58), 6.4±1.2 cm and 6.3±1.0 cm (p=0.71), respectively. Freedom from mild-moderate or greater AI at 6, 12, and 18 months post implant, in Group A and Group B was: 83% and 94% (p=0.40), 82% and 92% (p=0.69), 77% and 80% (p=0.77), respectively. Severity of mitral regurgitation was similar between groups at all time points. Lower BSA was the only characteristic predictive of developing mild-moderate or greater AI. Conclusions There does not appear to be a difference in the incidence of late aortic insufficiency in patients implanted with 3rd generation versus 2nd generation LVADs. Lower BSA continues to be associated with development of AI after LVAD.