title: Long-term left ventricular support in patients with a mechanical aortic valve.
abstract: OBJECTIVE
  The presence of a mechanical prosthesis has been regarded as an increased risk of thromboembolic complications and as a relative contraindication for a left ventricular assist device (LVAD). Five patients in our center had a mechanical aortic valve at the time of device implantation and were studied regarding thromboembolic complications.
  
  
  METHODS
  Five patients operated upon with an LVAD (1 HeartMate I™, 4 HeartMate II™) between 2002 and 2011 had a mechanical aortic valve at the time of implantation. The first patient had a patch closure of the aortic valve. In four patients, the prosthesis was left in place. Anticoagulants included aspirin, warfarin, and clopidogrel.
  
  
  RESULTS
  The average and accumulated treatment times were 150 and 752 days, respectively. Three of the five patients showed early signs of valve thrombosis on echo with concomitant valve dysfunction. Four patients were transplanted without thromboembolic events during pump treatment. One patient died from a hemorrhagic stroke after 90 days on the LVAD.
  
  
  CONCLUSIONS
  The strategy of leaving a mechanical heart valve in place at the time of LVAD implantation in five patients led to valvular thrombosis in three but did not provoke embolic events. It increased the complexity of postoperative anticoagulation.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiovascular Surgery, County Council of Östergötland, Linköping, Sweden. Henrik.ahn@lio.se
authors.forename: Henrik
authors.initials: H
authors.lastname: Ahn
authors.forename: Hans
authors.initials: H
authors.lastname: Granfeldt
authors.forename: Laila
authors.initials: L
authors.lastname: Hübbert
authors.forename: Bengt
authors.initials: B
authors.lastname: Peterzén
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000925:Anticoagulants