The Effect of Percutaneous Left Ventricular Assist Device Placement to the Native Aortic Valve Competency

Abstract

Impella percutaneous left ventricular assist devices (LVAD) (Abiomed, Danvers, MA) use is rapidly expanding for cardiogenic shock management. Devices are delivered through the aortic valve (AV). Due to the design, there remains concern that Impella may disrupt aortic valve morphology and competency, potentially causing secondary aortic insufficiency (AI) after explantation. Secondary AI could compromise cardiac function and may further reduce the efficacy of future mechanical circulatory support. Prior reports are limited and results remain unclear. The aim of this study is to characterize the relationship between Impella placement and AI after explantation. This was a single center retrospective analysis. All patients who had Impella LVAD support from April 2014 to August 2019 were included. Patient demographics, implant indications, duration of support, and pre- and post-implant echocardiograms were analyzed. Post-implant echocardiograms were analyzed at eight time points, with focus on the most recent finding. ASE guidelines were used to quantify AI. Impella CP and Impella 5.0 patients were sub-analyzed separately. A Mann Whitney U-test was performed on AI analysis. Any AV complications requiring surgical procedures were reviewed. 146 patients received Impella (CP: n= 104, 71.2%, 5.0: n=37, 25.3%, 2.5: n=5, 3.4%) support. Mean age was 63.8 years (16-88). 27.4% of patients were female (n=40). Mean days of support was 4.8 days (0-28). Mean follow up time was 70.2 days post-implant (0-1484 days). Indications were bridge to recovery, bridge to LVAD or heart transplant, ECPELLA, and high-risk PCI, respectively (n=57, 39.0%; n=19, 13.0%; n=18, 12.3%; n=52, 35.6%). The pre-implant and post-explant degree of AI is shown in figure 1. There was no statistically significant AI progression (p=0.76). One patient developed severe AI and required an AV replacement (0.68%). Although increasing AI post-Impella support is rare, careful follow up is warranted.