CARC12: Surgical Correction of De Novo Aortic Valve Insufficiency after Left Ventricular Assist Device Implantation

Abstract

Background: Development of significant aortic insufficiency (AI) is a common complication associated with prolonged support with continuous-flow left ventricular assist device (CF-LVAD). The aim of this study is to investigate the clinical outcomes after surgical correction of de novo AI after LVAD implantation. Methods: Between January 2013 and June 2022, 190 patients underwent CF-LVAD implantation. Of them, 24 had trivial or less AI before LVAD implantation and developed moderate or greater de novo AI after LVAD implantation. Those who had undergone aortic valve surgery before or concomitant with LVAD surgery were excluded. Among the 24 patients, surgeries were indicated for medically refractory de novo AI in 11 patients, who were included in the current study. Primary endpoint was post-operative improvement in hemodynamics as assessed with right heart catheter examination, and the secondary endpoint was 3-year survival and freedom from death and/or heart failure readmission rate. Results: Correction of de novo AI were accomplished with aortic valve closure with bovine pericardial patch in 10 patients and prosthetic valve replacement in one patient. After surgery, pulmonary artery wedge pressure (PAWP), and cardiac index (CI), mixed venous blood oxygen saturation (SvO2) significantly improved compared with preoperative baseline (Figure). The mean follow-up after LVAD implantation was 1413days, and the 3-year survival rate was 90.9%. The freedom from postoperative moderate or greater AI rate, and the freedom from heart failure readmission rate were both 90.9% at 3 years. Conclusion: In patients who were indicated for surgical correction of de novo AI after LVAD implantation, postoperative hemodynamic improvement and survival were considered favorable.Figure 1. Hemodynamic change in three states