Aortic Valve Opening Time, a Novel Parameter to Describe the Aortic Valve in Patients with Continuous Flow Devices

Abstract

Purpose Aortic valve opening in patients with continuous flow LVADs is felt to be important to prevent root stasis and minimize complications. Optimal characterization of the aortic valve opening has not been delineated. We described Aortic Valve Opening Time (AVOT), a novel quantitative measure of aortic valve opening in patients with continuous flow LVADs. Methods From April 2017 to August 2018, sequential patients implanted with HVAD had serial echocardiograms. Aortic valve opening status and AVOT were analyzed longitudinally at 3 month intervals. AVOT was measured using M-mode echocardiography, quantified as the time interval between initial aortic leaflet opening to leaflet closure. The longest AVOT of each echocardiogram was used. Results Over a period of 17 months, 24 patients were studied. Mean age was 52 ± 3 years, and 75% were male. The mean speed was 2627 ± 26 rpm. During longitudinal follow up post implant, the aortic valve always opened in 10 (42%), intermittently opened in 4 (16%) and remained closed in 10 patients (42%). For patients in whom the aortic valve persistently or intermittently opened, the mean AVOT was 110 ± 22 msec. Patients with AVOT longer than 150 msec had less aortic and mitral regurgitation compared to those with AVOT less than 150 msec, irrespective of frequency of aortic valve opening or device speed. Conclusion Aortic valve opening time is a novel characterization of the aortic valve in patients with continuous flow devices, independent of frequency of aortic valve opening. The relationship between the AVOT and outcomes needs to be defined.