Author + information
- Arudo Hiraoka,
- Pavan Atluri,
- James Kirkpatrick,
- Yasuhiro Shudo,
- John W. MacArthur,
- Jeffrey E. Cohen,
- Alexander S. Fairman and
- Y. Woo
Development of aortic insufficiency (Al) with continuous flow left ventricular assist device (LVAD) therapy is one of the most significant issues in mechanical circulatory support. The longitudinal trajectory, mechanisms and associated effects have not been fully determined.
We analyzed data from 96 patients who underwent continuous flow LVAD implantation at a single academic center between November 2005 and July 2012. LVADs included 81 HeartMate II, 13 HeartWare, and 2 VentrAssist. Preoperative Al grade was classified into 3 groups (none: 54, trace: 25, and mild: 17). De novo AI was defined as the development of mild or greater Al in patients with none or trace preoperative Al. We evaluated the longitudinal differences between the de novo Al group and no Al group at 1, 3, 7 and 12 months after LVAD implantation.
Except 2+ preoperative Al group, a significant increase of AI was found, with the most rapid development seen in the preoperative no Al group. De novo AI was observed in 42 patients. Compared to patients who did not develop Al, the de novo Al group had a greater percentage of patients with no opening of the aortic valve at 3 months (26 of 39, 67%, vs 11 of 31, 35%, P = 0.009) and 7 months (15 of 22, 68%, vs 7 of 19, 37%, P = 0.043) follow-up. LV end-diastolic dimension (LVDd), LV end-systolic dimension, mitral regurgitation and pulmonary artery systolic pressure (PASP) significantly decreased in all patients. In patients with no Al, LV ejection fraction increased and left atrial dimension (LAD) also decreased significantly (P = 0.015 and 0.005, respectively). In a subset of patients followed for > 12 months (n = 25), there were trends toward increases in the rate of change of LV diastolic and aortic diameters, LAD and PASP between preoperative and 1 year in those without Al (P = 0.060, 0.055, 0.085 and 0.080, respectively).
Under continuous flow LVAD support, absence of preoperative Al did not correlate with reduced risk for Al development. De novo Al was seen more often in patients without aortic valve opening. In patients without de novo Al, there were long-term trends toward enlarged aortic root diameter.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Heart Failure: Mechanical Circulatory Support
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 1260M-266
- 2013 American College of Cardiology Foundation