title: Surgical correction of aortic valve insufficiency after left ventricular assist device implantation.
abstract: OBJECTIVE
  New-onset aortic insufficiency (AI) can be encountered after instituting mechanical circulatory support and seems more common and severe with continuous flow (CF) left ventricular assist devices (LVADs) compared with pulsatile devices. Treatment algorithms for de novo, post-LVAD AI have not been well defined. In the present report, we have described 6 patients who underwent aortic valve surgery for new-onset post-LVAD AI.
  
  
  METHODS
  From 2005 to 2011, 271 patients underwent LVAD implantation. Of these LVADs, 225 were CF devices (203 HeartMate II devices, Thoratec Corp, Pleasanton, Calif; and 22 HVAD devices, HeartWare Intl, Inc, Framingham, Mass). The patients were examined for new-onset severe AI requiring surgical intervention.
  
  
  RESULTS
  During follow-up, 6 CF LVAD patients developed new, severe AI that was accompanied by heart failure. After medical therapy had failed, 4 patients underwent redo sternotomy for aortic valve procedures (1 bioprosthetic valve replacement, 1 Dacron patch closure, and 2 aortic valve repairs), and 2 patients underwent transcatheter aortic valve procedure, with 1 requiring revision by open surgery for aortic valve replacement. Of the 6 patients, 5 experienced significant improvement in functional capacity and symptoms. One patient died postoperatively secondary to multiorgan failure and sepsis.
  
  
  CONCLUSIONS
  Surgical treatment of post-LVAD AI with aortic valve oversewing or leaflet repair or by bioprosthetic aortic valve replacement is effective at restoring functional capacity for CF LVAD patients who develop symptomatic, severe AI and can be performed safely with good results. Various transcatheter approaches to these difficult problems are also available and offer less invasive alternatives to conventional surgery.
authors.affiliation: Department of Surgery, University of California-Davis, Sacramento, Calif; and Division of Cardiovascular and Thoracic Surgery.
authors.forename: B Zane
authors.initials: BZ
authors.lastname: Atkins
authors.forename: Zubair A
authors.initials: ZA
authors.lastname: Hashmi
authors.forename: Asvin M
authors.initials: AM
authors.lastname: Ganapathi
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Harrison
authors.forename: G Chad
authors.initials: GC
authors.lastname: Hughes
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
authors.forename: Carmelo A
authors.initials: CA
authors.lastname: Milano
mesh_terms: D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D002317:Cardiovascular Agents / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D020127:Recovery of Function; D012086:Reoperation; D012720:Severity of Illness Index; D056346:Sternotomy; D013536:Suture Techniques / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D002317:Cardiovascular Agents
keywords: 22; 27; 35.1; AI; AVR; CF; LVAD; aortic insufficiency; aortic valve replacement; continuous flow; left ventricular assist device