Aortic valve closure associated with HeartMate left ventricular device support: technical considerations and long-term results.
BACKGROUND
Aortic valve integrity is crucial for optimal left ventricular assist device (LVAD) support. Pre-existing native aortic insufficiency, aortic valve incompetence acquired during support, as well as previously placed prosthetic aortic valves present unique problems for these patients.


METHODS
We reviewed and analyzed data for 28 patients who underwent left ventricular outflow tract closure associated with HeartMate I (n =12) and HeartMate II (n = 16) LVAD insertion or exchange. Indications for valve closure, surgical technique, LVAD function, survival rates and complications were retrospectively analyzed. Survival rates were compared with those of HeartMate LVAD patients (n = 104) who did not undergo aortic valve closure.


RESULTS
Indications for closure included native aortic valve insufficiency (10 patients), aortic valve deterioration after prolonged LVAD support (8 patients) and previously placed mechanical (9 patients) or bioprosthetic aortic prostheses (1 patient). There were 2 operative and 5 late deaths (mean 227 days post-operatively). Of the deaths, none were due to aortic valve closure. Actuarial survival was 78% at 1 year and 53% at 3 years, which was statistically better than for our patients with an intact aortic outflow (61% at 1 year, 45% at 3 years; p < 0.05). Five patients had transplants, 1 patient was successfully bridged to recovery, and 15 patients remain on LVAD support. No patient with outflow closure developed regurgitation, embolization or compromised LVAD support.


CONCLUSIONS
Outflow tract closure in LVAD-supported patients is safe, often necessary and well tolerated.
Department of Cardiovascular Surgery, Sharp Memorial Hospital, San Diego, California 92123, USA. robandtl@aol.com
Robert M
RM
Adamson
Walter P
WP
Dembitsky
Sam
S
Baradarian
Joseph
J
Chammas
Karen
K
May-Newman
Suzanne
S
Chillcott
Marcia
M
Stahovich
Vicki
V
McCalmont
Kristi
K
Ortiz
Peter
P
Hoagland
Brian
B
Jaski
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D004868:Equipment Failure; D005260:Female; D006350:Heart Valve Prosthesis; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult