Is native aortic valve commissural fusion in patients with long-term left ventricular assist devices associated with clinically important aortic insufficiency?
BACKGROUND
Long-term left ventricular assist device (LVAD) support diminishes flow through the native aortic valve and decreases valve motion. This may cause aortic valve commissural fusion. The clinical importance of such fusion is not well understood.


METHODS
Thirty-three consecutive patients receiving long-term LVAD support were followed up until transplantation or death. In each case, the native aortic valve was examined pathologically for commissural fusion. Pathology findings were correlated with hemodynamic performance as assessed by both LVAD pump flow and echocardiography.


RESULTS
Seventeen of the 33 patients had some degree of native aortic valve commissural fusion. Four patients had fusion at 2 commissures; of these, 2 had clinically significant native valve aortic insufficiency (2+ or greater), and 1 exhibited trace insufficiency of the native aortic valve. Thirteen patients had fusion at only 1 aortic commissure; of these, 2 had clinically significant aortic insufficiency (2+ or greater), and 3 had trace or mild (1+) insufficiency of native aortic valve. Two of the 4 patients with fusion at 2 commissures required increased LVAD support of >3 liters/min/cm2. No patient with fusion of only 1 commissure required increased LVAD support. Three patients with no commissural fusion of the aortic valve required increased LVAD support secondary to sepsis.


CONCLUSIONS
Commissural fusion of the native aortic valve occurs in a significant number of patients receiving long-term LVAD support and can necessitate increased levels of LVAD support. Recognition of this phenomenon may allow development of strategies to minimize commissural fusion and extend LVAD pump life.
Department of Cardiothoracic and Vascular Surgery, Texas Heart Institute, St. Luke's Episcopal Hospital, University of Texas-Houston Medical School, Houston, Texas, USA. george.v.letsou@uth.tmc.edu
George V
GV
Letsou
John H
JH
Connelly
Reynolds M
RM
Delgado
Timothy J
TJ
Myers
Igor D
ID
Gregoric
Frank W
FW
Smart
O H
OH
Frazier
D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D013997:Time Factors; D014463:Ultrasonography