Development of De Novo Aortic Insufficiency in Patients with HeartMate 3

Abstract

Aortic insufficiency (AI) is common following continuous flow left ventricular assist device (CFLVAD) and is associated with morbidity and mortality. This study aims to assess the incidence of de novo AI in HeartMate 3 (HM 3) LVAD recipients and compare the outcomes with HeartMate II (HM II) patients. A retrospective review was conducted of clinical characteristics and serial echocardiograms (1 month, 6 months, and 1 year post implant) of 151 HM 3 patients implanted between Nov. 2014 and March 2019, as well as of 270 HM II patients implanted between April 2004 and Dec. 2015 at our center. Patients (n=30) were excluded from analysis for a history of aortic valve (AV) surgery, concomitant AV surgery with LVAD implant, or more than trace preoperative AI left untreated. De novo AI was defined as more than mild AI. In the HM 3 cohort, mean age was 58 ± 12 and 84% were male. 74% received HM 3 as destination therapy. Incidence and degree of de novo AI in each group is summarized in Figure 1. 4 patients were readmitted due to significant AI and heart failure symptoms. Cumulative incidence curves showed that the probability of de novo AI at 1 year was 8.4% in the HM 3 cohort vs. 13% in the HM II cohort (Figure 2, p=0.29). In both cohorts, patients who had AV opening on echocardiogram at 1 month post implant were significantly less likely to develop de novo AI (100% freedom from de novo AI at 1 year for HM 3 with open AV vs. 84% for HM 3 with closed AV, 97% for HM II with open AV vs. 76% for HM II with closed AV). The incidence of de novo AI is low and comparable between HM 3 and HM II patients at our center. AV opening at 1 month post implant appears to be protective of this complication.