Aortic Insufficiency and Clinical Outcomes in Patients Undergoing Aortic Valve Procedures at the Time of Continuous Flow Left Ventricular Assist Device Implantation

Abstract

Purpose Pts with aortic valve (AV) prostheses and/or preexisting aortic insufficiency (AI) typically undergo AV surgery at the time of continuous flow left ventricular assist device (CF-LVAD) implantation to prevent the development of valve thrombosis and clinically significant AI. However, the efficacy and long-term outcomes of such procedures remain unclear. Methods and Materials Baseline and postoperative echocardiograms and clinical records of all pts at our institution who received a HeartMate II (HMII) were reviewed. Pts who underwent manipulation of the AV either prior to or at the time of LVAD implantation were included. Results 46 pts met inclusion criteria. Mean age at the time of LVAD implantation was 66 ± 8 years, 89.1% were male, and 54.3% vs 45.7% underwent LVAD implantation as a bridge to transplantation or as destination therapy respectively. AV procedures at the time of implantation were performed in 6 (13.0%) pts with AV prostheses (3 closures, 2 repairs, and 1 replacement). All other pts underwent AV repair for preexisting AI which was mild or mild-moderate in 29 (63.0%), moderate in 10 (21.7%), and severe in 1 (2.2%). The mean total support time was 298 ± 257 days. No adverse events related to AV procedures were reported. 1 (2.2%) pt died within 30 days of implantation from refractory cardiogenic shock and 2 (4.3%) ischemic strokes occurred at postoperative day 20 and 91 in pts who required AV repair. 19 pts had undergone heart transplant at a mean of 221 ± 168 days post CF-LVAD support. 20 pts remained on LVAD support with a mean follow up of 418 ± 281 days, 1 pt required a device exchange for device thrombosis on postoperative day 40, and 6 had died after a support time of 187 ± 288 days. Only 2 (4.3%) pts went on to develop moderate AI or greater. Conclusions Surgical manipulation of the AV preformed concurrently at the time of CF-LVAD implantation in pts with AV prostheses or preexisting AI is safe and effectively prevents the development of clinically significant AI.