title: Development of aortic insufficiency in patients supported with continuous flow left ventricular assist devices.
abstract: Development of aortic insufficiency (AI) in patients supported with continuous flow left ventricular assist devices (LVAD) can adversely affect pump performance. In this study, we examined the incidence of new AI after LVAD implant at our institution. Pre- and postoperative echocardiograms of 66 patients who received HeartMate II or Heartware LVAD at our institution since June 2008 were reviewed for presence of new AI. Median LVAD support duration was 221 days. New AI developed in 6 patients (9.5%) after a median time of 374.5 days of support. There were no cases of severe or symptomatic AI. There was no significant difference between the AI incidence between HeartMate II and Heartware recipients. For patients who remained on LVAD support at 6 and 12 months, freedom from AI was 100% and 68.4%, respectively. Age, destination therapy status, and duration of support were predictors of new AI after LVAD implant. In conclusion, AI develops frequently during long-term support with continuous flow LVADs, particularly in those supported for longer than 6 months. As we move to the era of long-term LVAD support and destination therapy, further studies with longer follow-ups are required to determine the progression and clinical significance of AI in these patients.
authors.affiliation: Division of Cardiothoracic Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Hershey Heart & Vascular Institute, Pennsylvania 17033-0850, USA. bsoleimani@hmc.psu.edu
authors.forename: Behzad
authors.initials: B
authors.lastname: Soleimani
authors.forename: Annick
authors.initials: A
authors.lastname: Haouzi
authors.forename: Angela
authors.initials: A
authors.lastname: Manoskey
authors.forename: Edward R
authors.initials: ER
authors.lastname: Stephenson
authors.forename: Aly
authors.initials: A
authors.lastname: El-Banayosy
authors.forename: Walter E
authors.initials: WE
authors.lastname: Pae
mesh_terms: D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000209:etiology* / Q000503:physiopathology*; D002309:Cardiology / Q000379:methods; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000628:therapy*