Increased Morbidity and Mortality with Concomitant Aortic Valve Surgery in Patients Receiving a Continuous-Flow Left Ventricular Assist, an IMACS Database Analysis

Abstract

Significant aortic valve (AV) regurgitation is usually treated with AV replacement (AVR) or AV repair concomitant with left ventricular assist device (LVAD) surgery, as it can cause a closed-loop circulation, leading to a reduced left ventricular unloading and right ventricular (RV) function. However, data regarding survival after these AV procedures is limited. Therefore, the aim of this analysis was to evaluate the clinical outcome after concomitant AVR or AV repair in LVAD patients. All LVADs entered in the IMACS database between 2012 and 2016 were included in this analysis (n=15,267, mean age 56±13, 79% male). Outcomes up to 36 months post-LVAD surgery were compared between patients who underwent AVR (n=457), AV repair (n=328) or no AV surgery (n=14,482). The primary endpoint was a combined endpoint of overall survival, major bleeding events, and RV failure. Secondary we analyzed these endpoints separately. The probability of survival was calculated using the Kaplan-Meier method. Survival curves were compared using the log-rank test. The 36 months combined event-free survival was significantly lower in patients with concomitant AVR (23%) or AV repair (23%) compared to patients without AV surgery (30%) (p<0.01). The overall survival and major bleeding event-free survival was significantly lower in patients with AVR (45%, 17%,resp.) or AV repair (48%, 11%, resp.) compared to patients without AV surgery (54%, 32%, resp.) (p for both <0.01). In contrast, RV failure-free survival was higher in patients with AV repair (99.6%) compared to patients without AV surgery (91%) or AVR (92%) (p<0.01). In LVAD patients, AVR and AV repair were associated with a lower probability of overall survival and a higher probability of major bleeding events compared to patients without AV surgery. In contrast, the probability of RV failure was lower in patients with AV repair compared to patients without AV surgery or AVR.