Aortic Insufficiency Following Heartmate 3 Implant in Patients on Temporary Mechanical Circulatory Support

Abstract

<h3>Purpose</h3> Aortic insufficiency (AI) following continuous flow left ventricular assist device (LVAD) implant is a well-established complication associated with poor outcomes. Detailed assessment of aortic valve (AV) prior to LVAD implant may be challenging in critically ill patients supported with extracorporeal membranous oxygenation (ECMO) and/or Impella. This study aimed to investigate the risk of AI in HeartMate3 (HM3) recipients bridged from ECMO and/or Impella. <h3>Methods</h3> A single center retrospective review was conducted on all INTERMACS Stage 1 and 2 patients who were bridged to HM3 LVAD between 11/2014 and 10/2019 with intra-aortic balloon pump (IABP) alone or with ECMO/Impella. Patients were excluded for both repaired and unrepaired more than trace AI at the time of implant, post-LVAD endocarditis, or death during the index hospitalization. Echocardiograms at 1, 3, 6, and 12 months post-implant were reviewed and assessed for AI severity based on jet width and/or vena contracta. <h3>Results</h3> 17 patients bridged with ECMO/Impella and 50 patients bridged with IABP alone were enrolled to the study. The ECMO/Impella cohort consisted of 10 patients with ECMO and IABP, 2 with ECMO and Impella, 2 with ECMO alone, and 3 with Impella alone. There was no significant difference in age, sex, body mass index, strategy, and etiology of cardiomyopathy between two groups. Proportion of patients without AV opening at 1-month post implant were not significantly different (ECMO/Impella 47% vs. IABP 64%, p=0.26). Cumulative incidence of greater than mild AI during the first-year follow-up was 44% in Impella/ECMO group, compared to 16% in IABP cohort (p=0.038, Figure 1). <h3>Conclusion</h3> A higher incidence of AI was observed following HM3 LVAD implant in patients bridged with ECMO or Impella support than those bridged with IABP, potentially owing to difficulty assessing the AV in this critically ill population prior to LVAD implantation.