title: Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices.
abstract: BACKGROUND
  Left ventricular assist devices (LVADs) are increasingly used as long-term therapy for end-stage heart failure patients. We compared the prevalence of aortic insufficiency (AI) after HeartMate II (HMII) vs HeartMate XVE (HMI) support and assessed the role of aortic root diameter and aortic valve opening in the development of AI.
  
  
  METHODS
  Pre-operative and post-operative echocardiograms of 93 HMI and 73 HMII patients who received implants at our center between January 2004 and September 2009 were retrospectively reviewed. After excluding patients with prior or concurrent surgical manipulation of the aortic valve, with baseline AI, or without baseline echoes, 67 HMI and 63 HMII patients were studied. AI was deemed significant if mild to moderate or greater. Pathology reports were reviewed for 77 patients who underwent heart transplant.
  
  
  RESULTS
  AI developed in 4 of 67 HMI (6.0%) and in 9 of 63 HMII patients (14.3%). The median times to AI development were 48 days for HMI patients and 90 days for HMII patients. For patients who remained on device support at 6 and 12 months, freedom from AI was 94.5% and 88.9% in HMI patients and 83.6% and 75.2% in HMII patients (log rank p = 0.194). Aortic root diameters, as determined by echocardiography for the patients with AI, trended to be larger at baseline (3.43 ± 0.43 vs 3.15 ± 0.40; p = 0.067) and follow-up (3.58 ± 0.54 vs 3.29 ± 0.50; p = 0.130) compared with those who did not have AI. Aortic root circumferences were assessed directly by a pathologist in those patients who underwent transplant and were significantly larger in HMII patients who had developed AI compared with those patients who did not (8.44 ± 0.89 vs 7.36 ± 1.02 cm; p = 0.034). Lastly, AI was more common in patients whose aortic valve did not open (11 of 26 vs 1 of 14; p = 0.03).
  
  
  CONCLUSIONS
  Aortic insufficiency occurs frequently in patients who receive continuous-flow support with a HMII LVAD, and may be associated with aortic root diameter enlargement and aortic valve opening. These findings warrant a more thorough preoperative patient evaluation and additional studies to investigate the factors, that may be associated with AI development.
authors.affiliation: Division of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
authors.forename: Sang-Woo
authors.initials: SW
authors.lastname: Pak
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Sarah
authors.initials: S
authors.lastname: Cappleman
authors.forename: Robert
authors.initials: R
authors.lastname: Song
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.forename: Sandy
authors.initials: S
authors.lastname: Charles
authors.forename: Donna
authors.initials: D
authors.lastname: Mancini
authors.forename: Linda
authors.initials: L
authors.lastname: Gillam
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
mesh_terms: D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000628:therapy*