Thromboembolic Events in Patients with Concomitant Aortic Valve Surgery and Left Ventricular Assist Device Implantation, an IMACS Database Analysis

Abstract

Patients with significant aortic regurgitation at time of left ventricular assist device (LVAD) implantation, frequently need concomitant aortic valve (AV) replacement (AVR) or AV repair. The aim of this study was to investigate the risk for thromboembolic events (TE) in patients with concomitant continuous-flow LVAD and AV surgery. We used the international multicenter registry data from the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support (IMACS) registry of LVAD patients, implanted between January 2013 until September 2017. Differences between AVR, AV repair and non-AVR/repair patients were analyzed. In total, 785 (5.1%) out of the total 15267 patients (mean age 56±13 years, 79% male) received concomitant AVR/repair during LVAD surgery (mean age 60±11 years, 89% male); 386(2.5%) patients had biological prosthesis, 71 (0.5%) mechanical prosthesis and 328 (2.1%) AV repair. Follow-up was complete in 644 out of 785 (82%) patients, with a median follow-up of 11.8 months [IQR 4.8-23.4]. In total, TE occurred in 3135 cases; 2976 out of 12317 (24%) in patients without AV surgery, 73 out of 316 (23%) with a biological prosthesis, 73 out of 267 (27%) with an AV repair, and 13 out of 61 (21%) with mechanical prosthesis. The Figure shows that early (90-day) post LVAD, TE rate was significantly higher in the mechanical prosthesis group compared to the remaining cohort. However, at 2-years of follow-up, none of the concomitant surgery modalities were associated with higher TE rates. In patients treated with concomitant AVR or AV repair during LVAD surgery, a significant higher rate of early TE's was found in the mechanical prosthesis group. However, after 2-year follow-up, this differences was no longer significant. Caution in the early postoperative period is warranted when concomitant mechanical prosthesis is scheduled.