title: Aortic valve procedures at the time of ventricular assist device placement.
abstract: BACKGROUND
  Placement of a ventricular assist device (VAD) may lead to reduced or absent opening of the aortic valve and thus increase risk of thrombus formation in the aortic root as well as on the valve itself. The outcome of additional procedures to the aortic valve at the time of VAD placement is unclear.
  
  
  METHODS
  A retrospective analysis of 712 VAD patients from 1995 to 2009 was performed.
  
  
  RESULTS
  Twenty-eight patients were identified who underwent aortic valve procedures in addition to VAD placement. Indication for VAD placement was bridge to transplant in 23 patients, destination therapy in 4, and postcardiotomy shock in 1. Aortic valve procedures were performed for preexisting mechanical aortic prosthesis in 8 (7 closure and 1 aortic valve replacement with biological prosthesis), and for moderate or severe aortic insufficiency in 20 patients (10 repair, 9 closure, and 1 aortic valve replacement with biological prosthesis). At the last follow-up, 16 patients had undergone heart transplant, 6 remained on VAD support, and 5 had died. While on VAD support, no adverse events related to the aortic valve procedures occurred. The 30-day operative mortality was 0.4%. No clinical thromboembolic events were observed. In 2 patients, there was evidence of thrombus formation in the explanted heart. Four patients had bleeding complications. Of the 9 patients who received aortic valve repair, 2 had recurrent aortic insufficiency on echocardiograms during an average follow-up of 118 days.
  
  
  CONCLUSIONS
  Additional procedures to the aortic valve at the time of VAD placement are feasible. Overall outcomes are comparable to those seen in patients without the need for aortic valve manipulation at the time of VAD placement.
authors.affiliation: Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Goda
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Sang-Woo
authors.initials: SW
authors.lastname: Pak
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.forename: Donna
authors.initials: D
authors.lastname: Mancini
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 / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology / Q000517:prevention & control; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013927:Thrombosis / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome