Aortic Insufficiency is Associated with Hemocompatibility-Related Adverse Events in LVAD Patients

Abstract

Purpose Hemocompatibility-related clinical adverse events (HRAEs) are major causes of readmission and reduce quality of life in LVAD patients. The impact of aortic insufficiency (AI) on HRAEs remains uncertain. This study assessed the impact of AI, which was graded by using novel Doppler echocardiographic parameters obtained at the LVAD outflow cannula , on HRAEs. Methods LVAD patients with varying degrees of AI underwent Doppler echocardiography of the LVAD outflow cannula. AI regurgitation fraction (RF) was calculated from the systolic/diastolic velocity ratio and the rate of diastolic flow acceleration of the LVAD outflow cannula (Figure 1A). RF >30% defined as significant AI. Freedom from any HRAEs and the net burden of HRAEs, which was calculated by using a hemocompatibility score (with 4 escalating tiers of hierarchal severity), were compared between those with/without significant AI during a 1-year observational period. Results Among 105 patients (median age 56 years, 76% male), 36 patients (34%) had significant AI. Baseline characteristics were comparable between two groups (p >0.05 for all). One-year survival free from HRAEs was 44% in the significant AI group compared with 67% in the non-significant AI group (p = 0.018; Figure 1B). The average hemocompatibility score in the significant AI group was higher compared with the non-significant AI group (1.72 vs. 0.64; p = 0.009; Figure 1C), due to higher tier I (gastrointestinal bleedings or medically managed pump thrombosis ; p = 0.034) and tier IIIB scores (HRAE-related death; p = 0.011). Conclusion Significant AI, which was assessed by using novel Doppler echocardiographic parameters, was associated with an increased rate of HRAEs in LVAD patients.