VAD Therapy Research Articles

Clinical and economic impact of ventricular assist device infections: a real-world claims analysis

Background VAD therapy has revolutionized the treatment of end-stage heart failure, but infections remain an important complication. The objective of this study was to characterize the clinical and economic impacts of VAD-specific infections. Methods A retrospective analysis of a United States claims database identified members ≥ 18 years with a claim for a VAD implant procedure, at least 6 months of pre-implant baseline data, and 12 months of follow-up between 1 June 2016 and 31 December 2019. Cumulative incidence of infection was calculated. Infection and non-infection cohorts were compared regarding mortality, healthcare utilization, and total cost. Regression models were used to identify risk factors associated with infections and mortality. Results A total of 2,259 patients with a VAD implant were included, with 369 experiencing infection (12-month cumulative incidence 16.1%). Patients with infection were 2.1 times more likely to die (p < 0.001, 95% CI [1.5–2.9]). The mean 12-month total cost per US patient was $354,339 for the non-infection cohort and $397,546 for the infection cohort, a difference of $43,207 (p < 0.0001). Conclusions VAD infections were associated with higher mortality, more healthcare utilization, and higher total cost. Strategies to minimize VAD-specific infections could lead to improved clinical and economic outcomes.

Abstract 12670: The End-of-Life Experience of Pediatric Vad Patients: A Report From the Action Registry

Introduction: Although most pediatric VAD patients survive to transplantation, some die on device therapy. The end-of-life experience of pediatric VAD patients is not well characterized. Hypothesis: Invasive interventions are common in pediatric VAD patients at the end-of-life. Methods: Retrospective review of pediatric VAD patients in the ACTION registry who died on device therapy between 3/2012-9/2021. Demographic and clinical data, including invasive interventions used at the end-of-life and the location of death, were analyzed. Results: 107/721 (15%) of patients died on device at a median age of 5 years (IQR:1, 16) at 43 days (IQR: 17, 91) post implant. Goals of VAD therapy were bridge to candidacy for 50 patients (51%), bridge to transplant for 44 (37.6%), destination therapy for 2 (1.7%). The most common cause of death was multi-organ failure (n=35, 30%), followed by infection (n=12, 10.3%). Eighty-five of 92 patients (92.4%) died with a functioning device in place. Most patients were receiving invasive interventions (mechanical ventilation, 75%; vasoactive infusions, 62%) at the end-of-life. ( Table 1 ). Only 10 (9%) patients died at home. Utilizing these data, we identified and estimated the frequency of four common end-of-life trajectories for pediatric VAD patients. (Figure 1). Conclusions: Aggressive interventions are common at the end-of-life of pediatric patients with VADs. Dying at home is uncommon. Identification of common end-of-life patterns will serve as an outcome measure and inform future practices to promote informed patient and provider decision-making to reduce suffering in those who die on device support.

Ventricular assist devices in paediatric cardiomyopathy and congenital heart disease: An analysis of the German National Register for Congenital Heart Defects

BackgroundVentricular assist devices (VAD) are increasingly used in patients with end-stage heart failure due to acquired heart disease. Limited data exists on the use and outcome of this technology in children. MethodsAll children (<18 years of age) with VAD support included in the German National Register for Congenital Heart Defects were identified and data on demographics, underlying cardiac defect, previous surgery, associated conditions, type of procedure, complications and outcome were collected. ResultsOverall, 64 patients (median age 2.1 years; 45.3% female) receiving a VAD between 1999 and 2015 at 8 German centres were included in the analysis. The underlying diagnosis was congenital heart disease (CHD) in 25 and cardiomyopathy in 39 children. The number of reported VAD implantations increased from 13 in the time period 2000–2004 to 27 implantations in the time period 2010–2014. During a median duration of VAD support of 54 days, 28.1% of patients experienced bleeding complications (6.3% intracerebral bleeding), 14.1% thrombotic (10.9% VAD thrombosis) and 23.4% thromboembolic complications (including cerebral infarction in 18.8% of patients). Children with cardiomyopathy were more likely to receive a cardiac transplantation (79.5% vs. 28.0%) compared to CHD patients. Survival of cardiomyopathy patients was significantly better compared to the CHD cohort (p < 0.0001). Multivariate Cox-proportional analysis revealed a diagnosis of CHD (hazard ratio [HR] 4.04, p = 0.001), age at VAD implantation (HR 1.09/year, p = 0.04) and the need for pre-VAD extracorporeal membrane oxygenation (ECMO) support (HR 3.23, p = 0.03) as independent predictors of mortality. ConclusionsThe uptake of VAD therapy in children is increasing. Morbidity and mortality remain high, especially in patients with congenital heart disease and those requiring ECMO before VAD implantation.

R38 Ten Year Outcomes for Intermacs Class 1 Patients Receiving VAD Therapy

The INTERMACS Class 1 designation is reserved for the most acutely ill group of heart failure patient, where life-threatening hypotension despite rapidly escalating inotropic support necessitate urgent intervention.

LEFT VENTRICULAR ASSIST DEVICE EXPLANTATION AFTER CARDIAC RECOVERY

Objectives: Left ventricular assist device (LVAD) treatment may lead to reverse remodeling in heart failure patients and functional cardiac recovery. The ultimate goal after mechanical circulatory support allows explantation of the left ventricular assist device (LVAD). Here, we present our experience with VAD explantation after cardiac recovery including industry and off-label surgical strategies for pump removal. Methods: We retrospectively analysed 320 LVAD implantations performed in our institution between 01/2009 and 12/2018. Exclusion criteria were pediatric VAD, use of BiVAD, and unplanned pump removal due to thrombosis. Eligibility for pump explantation was evaluated following hemodynamic ECHO and cardiac CT measurements. Baseline characteristics and clinical course of explanted VAD patients were collected preVAD, on pump and during follow up after pump removal. Results: 11 VAD patients could be successfully weaned from LVAD support (3.4%) and underwent surgery for pump explantation. The devices used for circulatory support included pulsatile Berlin Heart Excor and newer generation continuous flow Incor, Heartware, HeartMate 3. All 11 patients survived perioperative period resulting in a 100% 30 day survival. 1 recovery patient died within the first year due to non cardiac reason and another after 684 days, respectively. Only 1 cardiac recovery patient deteriorated and finally died 7 years after explantation. Mean follow-up time of survived patients averages 5.2 years. At latest follow-up 91.7% of BTR patients had a return to an absolute LVEF to greater than 40%. Conclusion: The removal of VAD after cardiac recovery is feasible and can safely be performed using different surgical strategies including redo sternotomy and lateral thoracotomy. Strictly following weaning protocols from VAD therapy individualized strategies need to be explained to the patients including off label plugs for newer generation Heartware and HeartMate 3.

In Silico and in Vitro Conductivity Models of the Left Heart Ventricle.

Ventricular Assist Devices (VADs) are used to treat patients with cardiogenic shock. As the heart is unable to supply the organs with sufficient oxygenated blood and nutrients, a VAD maintains the circulation to keep the patient alive. The observation of the patient's hemodynamics is crucial for an individual treatment; therefore, sensors to measure quantifiable hemodynmaic parameters are desirable.In addition to pressure measurement, the volume of the left ventricle and the progress of muscle recovery seem to be promising parameters. Ongoing research aims to estimate ventricular volume and changes in electrical properties of cardiac muscle tissue by applying bioimpedance measurement. In the case where ventricular insufficiency is treated by a catheter-based VAD, this very catheter could be used to conduct bioimpedance measurement inside the assisted heart. However, the simultaneous measurement of bioimpedance and VAD support has not yet been realized, although this would allow the determination of various loading conditions of the ventricle. For this purpose, it is necessary to develop models to validate and quantify bioimpedance measurement during VAD support.In this study, we present an in silico and an in vitro conductivity model of a left ventricle to study the application of bioimpedance measurement in the context of VAD therapy. The in vitro model is developed from casting two anatomical silicone phantoms: One phantom of pure silicone, and one phantom enriched with carbon, to obtain a conductive behavior close to the properties of heart muscle tissue. Additionally, a measurement device to record the impedance inside the ventricle is presented. Equivalent to the in vitro model, the in silico model was designed. This finite element model offers changes in material properties for myocardium and the blood cavity.The measurements in the in vitro models show a strong correlation with the results of the simulation of the in silico model. The measurements and the simulation demonstrate a decrease in impedance, when conductive muscle properties are applied and higher impedances correspond to smaller ventricle cross sections.The in silico and in vitro models are used to further investigate the application of bioimpedance measurement inside the left heart ventricle during VAD support. We are confident that the models presented will allow for future evaluation of hemodynamic monitoring during VAD therapy at an early stage of research and development.

Parental responsibility for pediatric ventricular assist devices: Views of families on the acceptability of hospital discharge.

Paracorporeal pediatric VAD therapy requires hospital residency due to device and patient factors. Discharge home is potentially possible with a mobile driving unit. This study aimed to investigate family views on hospital discharge of a child on VAD. Qualitative methodologies were adopted. We undertook 24 interviews of families who had a transplanted child previously on a VAD, and participant observations of two families who were current VAD patients residing in hospital. Families experienced overwhelming emotions as they spent time adjusting to the diagnosis, the need for transplant, family separation, and financial concerns. Despite many parents being partially/fully trained on the VAD, the majority would be reluctant to be discharged, fearing emergencies, high burden of care needs, and social isolation. Three families with a child on a Berlin Heart expressed willingness to reside in the hospital accommodation at least part-time, to facilitate private family time. One child on HeartWare was discharged home, with another going through the discharge process. Discharge was not acceptable to most families if this meant downgrading their child's transplant listing urgency status. Parents and children on VAD value independence and some private family time but not at the perceived expense of safety. Families preferred their child on VAD to remain resident in hospital even if mobility is improved with a mobile driving device. Parental education should acknowledge the high burden on families, risks of a remote setting and offer intermediate residency options. It cannot be assumed families want hospital discharge.

Maternal experiences of caring for a child with a ventricular assist device.

The purpose of this study was to gain a deeper understanding of maternal experiences of caring for their child with a VAD at home as a bridge to transplant. A descriptive, qualitative study was conducted via telephone-recorded guided interviews. Participants were caring for or had a child with a VAD between 4 and 16years old. Data collection occurred over a 12-month period. Using the snowball sampling technique, a purposeful sample of mothers (n=6) was consented and completed the interview. The data were analyzed using an iterative process of thematic analysis. Five themes emerged: physical modifications, the loss of independence, the emotional rollercoaster, support from others, and transitions on and off the device. We introduced new evidence about sleep, contraception, and heart transplantation, and how VAD therapy impacts childhood development. The mean duration of VAD support was 263±170days. Five children had heart transplants by the time of interview. To the best of our knowledge, this is the first qualitative study in the US that explores maternal experiences of caring for a child who is living at home with a VAD. VAD therapy is a novel approach to managing advanced heart failure among children and presents unique challenges when caring for them at home. Results provide insight into the education, physical environment, and support needed by parents.

Regression of renal amyloid deposits by VAD therapy plus autologous stem cell transplantation in a patient with primary AL amyloidosis

We report a 58-year-old Japanese woman who presented with nephrotic syndrome. Steroid therapy and cyclosporine A administration were initiated, but hematological remission and renal response were not achieved. Renal biopsy revealed amyloid deposits in the mesangial region and the small arteries. Proteomic analysis based on laser microdissection and mass spectrometry showed that the amyloid deposits were composed of the constant region of the lambda light chain. She received vincristine, adriamycin, and dexamethasone therapy followed by high-dose melphalan and autologous stem cell transplantation, resulting in hematological complete remission and renal response with negative urinary Bence-Jones protein and proteinuria. Renal biopsy was performed four times during follow-up, demonstrating that amyloid deposits decreased gradually, while glomeruli showing global sclerosis increased from 3 to 62%. This case suggests that glomerular amyloid deposits can be cleared via tissue remodeling, if stem cells producing amyloid precursors are completely replaced by unrelated cells after stem cell transplantation.

Lack of Social Support is Not a Contraindication to VAD Therapy

Purpose Long term VAD therapy is a highly complex treatment modality, posing significant challenges to patients, medical teams and allied health professionals. Traditionally lack of social support and social isolation for patients has raised concerns for hospital teams. We have reviewed our cohort of patients at a single centre to determine if lack of social support and isolation affects patients’ long term survival. Methods A total of 315 patients were reviewed, having undergone continuous flow VAD as a bridge to transplantation. 50 patients were identified as having a lack of social support at the time of implant and during their VAD journey. This was defined as patients who lived alone, with little or no carers. Survival data was reviewed at yearly intervals at year 1, 2 and 3. Data was censored if the VAD therapy was discontinued during this period at time of death, time of transplant or time of myocardial recovery at decommission. Results 86% of patients were still alive at year 1, with no transplants or decommissioning occurring in this period. (see table 1). Year 2 survival was 58% with 5 deaths, 3 transplants and 1 decommissioning and year 3 was 64% survival with 2 transplants occurring in that period. This was then compared to overall survival data at our own centre and the national average for VAD survival as detailed in the NHSBT report 2016. The results were favourable for the lack of social support in comparison to the national survival data, with 1 year survival higher in the lack of social support cohort at 86% compared with national % of survival ranging from 62-83% per centre. Year 2 survival at 58% compared to 56-73% respectively and year 3 survival at 64% compared with 48-65 %. Conclusion Our data shows that a lack of social support group should not prohibit the introduction of VAD therapy. Careful monitoring of all patients should be provided long term to enhance all patient survival

Cleavage and Re-Supply of von Willebrand Factor in Continuous Flow Blood Pump

Purpose Mechanical circulatory support devices are needed to enable recovery or provide a bridge to decision for patients with heart failure. The effectiveness of extending treatment duration in this therapy was previously reported to increase adverse events, such as acquired von Willebrand disease and gastrointestinal bleeding. Blood-related damage caused by medical devices is one of the most critical parameters needed to determine the performance of medical devices. For the treatment of these complications, we considered that it is very important to analyze the relationship between the cleavage of von Willebrand factor (VWF) due to shear stress and re-supply of VWF from activated platelets during blood pump circulation. We aimed to examine the alterations in the dynamics of VWF multimers in the circulating blood during VAD therapy. Methods In this study, two types (axial and centrifugal) of implantable blood pumps and a disposable blood pump (centrifugal type) for temporary use were used. A simple mock circulation test (5L/min, 100 mmHg) was performed to investigate with both whole-blood samples and platelet-poor plasma (PPP) using fresh bovine blood. Results In an analysis based on SDS-agarose gel electrophoresis and serum VWF values (antigen and activity), high-molecular-weight multimers (HMWMs) in VWF are reduced immediately after the initiation of blood circulation using the axial flow pump, and it had plateaued 60 minutes later. On the other hand, in the study using a centrifugal pump, cleavage of the HMWMs compared to that in the case of using a centrifugal pump was very slight. Moreover, in the whole-blood sample study, HMWMs reduced once, and it had been observed to recover after 60 minutes. However, HMWMs in the PPP sample was observed to reduce continuously during a circulation test. Conclusion In this result, the dynamics of VWF within the blood pump was shown to depend on the type of the blood pump, and this study demonstrated that re-supply of VWF due to platelet activation and cleavage of VWF due to shear stress in the pump occurred at the same time by circulating within the blood pump.

Getting Past the Spin: The CorWave LVAD, a Membrane Wave Pump Providing Physiologic Pulsatility without High Shear

Purpose A new LVAD is under development which employs a completely novel pumping technology. Magnetically driven oscillation of a polymer membrane creates a wave motion, gently pushing the blood through the pump. By changing the oscillation frequency and magnitude, pressure generation and blood flow rates can be dynamically adjusted over timescales as short as 30 msec. This approach offers a less damaging method for efficiently pumping blood while generating physiologic pulsatility. We evaluated pump actuation parameters and control algorithms in mock circulation loops and an acute animal study to evaluate and optimize pulse generation. Methods The LVAD was evaluated on a physiologic mock-loop to determine the optimal performance parameters. Pulsatility is created by switching rapidly between levels of pump output. A period of high output was generated following detection of systole to augment native cardiac output. Pump flow was reduced during diastole to avoid suck-down of the ventricle and limit back flow. The initial target was pump generated aortic dP/dt of >400 mmHg/sec under heart failure conditions with pump flow of 3-6 LPM. In parallel, hemolysis was measured using porcine blood. The pulsatility algorithm was evaluated with the pump implanted in an ovine model to validate the systole detection method. Results Evaluation on the mock circulatory loop achieved a high degree of pulsatility, defined as delta AoP=40mmHg, dP/dt=410mmHg/s, AoF=4.7 lpm, MAP=83mmHg vs. heart failure model of delta AoP=28mmHg, dP/dt=430mmHg/s, AoF=3.7lpm, MAP= 67mmHg. Generation of free hemoglobin at both high and low operating points are in a clinically acceptable range and well controlled transition between the two points does not significantly increase hemolysis. The acute animal study, the pulsatility algorithm correctly detected systole in >90% of beats. Conclusion Bench testing indicated that the pump provided augmented pulsatility to the failing heart, while achieving targeted levels of aortic flow and pressure without increased hemoglobin release. Augmented pulsatility offers a new mechanism to reduce bleeding and renal complications of VAD therapy with the intriguing possibly to increase cardiac recovery. Studies are underway to further evaluate the pulsatile operating mode algorithms and related hemoglobin release in an ovine heart failure model.

Role of ECMO as Bridge to VAD Therapy in Critically Ill Pediatric Patients - An Analysis of the STS Pedimacs Database

Purpose Extra-corporeal membrane oxygenation (ECMO) as bridge to ventricular assist device (EB-VAD) therapy is frequently used for initial resuscitation of critically ill pediatric patients (INTERMACS 1 & 2). Data regarding outcomes with this strategy is limited. Methods INTERMACS 1 & 2 patients enrolled in Pediatric Interagency Registry for Mechanical Circulatory Support (PEDIMACS) between September 19th, 2012 & December 31st, 2017 constituted the study group. Of 370 patients, 271 received primary VAD (P-VAD) implantation & EB-VAD was utilized in 99 patients. Patient characteristics, durable VAD outcomes & time to first adverse event with & without preoperative ECMO bridge were compared. Sub-analysis of INTERMACS 1 patients was conducted. Results Lower age (p=0.0001) & critical cardiogenic shock(p tube feeding , mechanical ventilation & paralytics (p Conclusion In INTERMACS 1 & 2 patients EB-VAD strategy is associated with poor early & late post-implant survival. Within INTERMACS 1 early survival is comparable with both strategies. EB-VAD could potentially benefit high risk INTERMACS 1 patients

Argatroban administration as therapy for thrombosis in patients with continuous-flow ventricular assist devices.

Device thrombosis is one of the main complications in left ventricular assist devices (LVAD) therapy and remains a challenging issue. Data on device thrombosis management, especially on the application of direct thrombin inhibitors such as argatroban, is limited and a consensus on thrombosis management has not yet been established. In this study we analysed retrospective clinical data obtained from 26 patients on VAD therapy who received argatroban for suspected VAD thrombosis, between April, 2012 and February, 2017. Thirteen patients (50%) showed resolution of thrombus after argatroban therapy. Eight of 26 patients (30.8%) were free of thrombotic events 90 days after discharge. Argatroban therapy was unsuccessful in 13 patients of the study cohort, leading to subsequent VAD-exchange. Six of 13 patients with first VAD-exchange had no thrombotic events 90 days after discharge. Six patients (23.1%) suffered from bleeding, especially gastrointestinal bleeding. No hemorrhagic strokes were observed. Three patients (11.5%) did not survive the follow-up period. Argatroban appears to be an alternative to other pharmacological treatment options in VAD thrombosis. Efficacy and safety characteristics are acceptable, but further investigation on larger populations is necessary.

Expert Interviews: Infrastructural Needs and Expected Benefits of Telemonitoring in VAD Therapy

Expert Interviews: Infrastructural Needs and Expected Benefits of Telemonitoring in VAD Therapy

Management of Hemostasis for Pediatric Patients on Ventricular-Assist Devices.

Ventricular-assist devices (VADs) have seen increased utilization in the pediatric population. Formerly, this therapeutic modality was limited to only the pulsatile VAD, EXCOR (Berlin Heart GmbH). However, the continuous flow VAD devices, HeartMate II (Abbott Inc.) and HeartWare (Medtronic Inc.), are now increasingly used in this population. Postoperatively, VAD patients are acutely anticoagulated using unfractionated heparin, often beginning 24 to 48 hours after VAD placement. Once the patient is stabilized and ready to transition to a lower acuity or outpatient setting, low-molecular-weight heparin or warfarin therapy may be instituted. Also, because of the risk for thrombotic and thromboembolic complications, antiplatelet strategies are employed using medications such as aspirin, clopidogrel, or dipyridamole. Platelet-rich plasma or whole blood platelet aggregation studies, platelet function analyzer-100 (Siemens), VerifyNow (Accriva Diagnostics), or thromboelastography platelet mapping (Haemonetics) may be used to help monitor antiplatelet effects, though the interpretation of the strength of the antiplatelet effect remains difficult. Care must be taken to monitor the hematologic complications of VAD, including acquired von Willebrand syndrome, which increases the risk for bleeding, and intravascular hemolysis, which increases the risk of thrombosis. Appropriate device placement and anticoagulation management are imperative to help avoid neurological dysfunction and ischemic stroke, the most devastating potential complications of VAD therapy. As our experience grows, we continue to gain an increased understanding of the management of anticoagulation, need for antiplatelet medication, and appropriate monitoring for these critical patients.

(1326) - Need for Palliation in VAD Therapy? Who? When? How?

(1326) - Need for Palliation in VAD Therapy? Who? When? How?

(733)Current Practice of Anticoagulation for Pediatric VAD Therapy - A Multi-Institutional European Survey of the EXCOR Pediatric Investigator Group (EEPIG)

(733)Current Practice of Anticoagulation for Pediatric VAD Therapy - A Multi-Institutional European Survey of the EXCOR Pediatric Investigator Group (EEPIG)

Abstract 212: Incidence of Depression and Anxiety in Patients With Durable Left Ventricular Assist Device

Incidence of Depression and Anxiety in Patients with Durable Ventricular Assist Devices Background: There is a high incidence of depression in patients with heart failure and the presence of depression is associated with worse outcomes. There have been few reported data on depression in patients with left ventricular assist devices (LVADs). Methods: Patients with LVAD were seen by a palliative care practitioner embedded in the cardiology/CT surgery outpatient clinic at a large quaternary care hospital as part of routine post VAD management. The patients were screened for anxiety and depression as part of the palliative care clinical assessment, using previously validated PHQ-9 and GAD-7 tools. Their scores were entered into a QI database. Patients were considered to have scores concerning for depression if the total PHQ-9 score was greater than or equal to 10 (moderate depression) or if they met USPTF scoring criteria for major or other depressive disorders. Scores of greater than or equal to 10 on the GAD-7 were considered concerning for generalized anxiety disorder. Results: 129 unique post LVAD patients were seen over 40 months, over a timeframe of 3 months to 5 years post implant. Of these, 110 (85%) were screened for depression using the PHQ-9 tool, usually at the first visit, or at a second follow up visit. 20 (18%) of those surveyed had met the above criteria for at least moderate depression, and 6(5%) had scores ≥ 15 consistent with at least moderate to severe depression. 83 were surveyed for anxiety using the GAD-7, and 8 (10%) had scores ≥ 10. Four patients had significant scores for both anxiety and depression. Of those patients who screened positive for significant depression, most (13/20, 65%) had a history of depression and were on antidepressants (13/20, 65%). Conclusion: The incidence of depression and/or anxiety in patients with LVAD, although higher than that of the general population (depression reported as 5-9%), appears to be on the low end of par with that reported in heart failure (depression incidence reported as 13-48% in the outpatient HF population). In our cohort, depression or anxiety were primarily observed in patients who already had a history of such. This finding is somewhat reassuring in that VAD therapy does not appear to induce these symptoms de novo. Nonetheless, patients with such a history are likely at risk for worsening symptoms with the significant stressor of undergoing VAD implant. Given the negative impact of depression on quality of life, this population should be carefully screened and supported both pre and post VAD implant.

(594) - Aortic Valve Interventions: Durability and Morbidity in Patients on Continuous Flow LVAD Support

Aortic valve repair or replacement (AVR) may reduce AI development after continuous flow (CF) LVAD implant and theoretically could reduce the risk of recurrent heart failure after LVAD, especially in those for whom long term support is anticipated. The aim herein is to evaluate the durability and morbidity associated with aortic valve (AV) interventions in CFLVAD patients. A retrospective, multicenter, analysis of CFLVAD patients with AV interventions was conducted. Kaplan-Meier estimates of survival were calculated. Cumulative frequencies of gastrointestinal bleeds (GIB), peripheral embolism, and VAD thrombosis were tallied. Severity of AI at last follow-up echocardiogram was measured. Of the 37 patients studied, 35 underwent AV intervention at the time of CFLVAD implant and 2 had preexisting bioprosthetic AVR left unadultered. Median [25th, 75th] patient age was 61 [53,68] years and 51% were supported for destination therapy. Operative AV interventions at the time of VAD included 24 (65%) AV repairs, 7 bioprosthetic AVRs (19%), and 4 AV occlusions (11%) for prior mechanical AVRs. Over a median 304 (mean 510) days of patient support, there were 14 deaths with 1 and 2 year survivals of 71±8.5% and 58±11%. Freedom from VAD hemolysis at 1 year was 90±5.8% with an overall event rate of 0.17 per patient-year (PPY) of support. GIB and peripheral embolism occurred at events rates of 0.21 PPY and 0.12 PPY, respectively. Echocardiograms performed a median 306 [147,703] days after VAD implant showed the presence of mild-moderate AI in 1 patient and <= mild AI in the remaining patients. AV interventions are a durable means of reducing postLVAD AI. The requirement for AV intervention is associated with lower survival and increased device thrombosis. The benefits of VAD therapy in patients requiring AV intervention should be weighed against the increased risks associated with AV interventions.