title: Prevalence, significance, and management of aortic insufficiency in continuous flow left ventricular assist device recipients.
abstract: BACKGROUND
  Aortic insufficiency (AI) is increasingly recognized as a complication of continuous flow left ventricular assist device support; however, its long-term prevalence, clinical significance, and efficacy of potential interventions are not well known.
  
  
  RESULTS
  We studied the prevalence and management of AI in 232 patients with continuous flow left ventricular assist device at our institution. Patients with aortic valve (AV) surgery before left ventricular assist device implantation were excluded from analysis. To examine the prevalence of de novo AI, patients without preoperative AI were divided into a retrospective and a prospective cohort based on whether a dedicated speed optimization study had been performed at the time of discharge. Forty-three patients underwent AV repair at the time of implant, and 3 subsequently developed greater than mild AI. In patients without surgical AV manipulation and no AI at the time of implant, Kaplan-Meier analysis revealed that freedom from greater than mild de novo AI at 1 year was 77.6±4.2%, and that at least moderate AI is expected to develop in 37.6±13.3% after 3 years. Nonopening of the AV was strongly associated with de novo AI development in patients without prospective discharge speed optimization. Seven of 21 patients with at least moderate AI developed symptomatic heart failure requiring surgical intervention.
  
  
  CONCLUSIONS
  AI is common in patients with continuous flow left ventricular assist devices and may lead to clinical decompensation requiring surgical correction. The prevalence of AI is substantially less in patients whose AV opens, and optimized loading conditions may reduce AI prevalence in those patients in whom AV opening cannot be achieved.
authors.affiliation: Divisions of Cardiology and Cardiothoracic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, NY.
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.forename: Nadav
authors.initials: N
authors.lastname: Nahumi
authors.forename: David
authors.initials: D
authors.lastname: Bejar
authors.forename: Jose
authors.initials: J
authors.lastname: Gonzalez-Costello
authors.forename: Sunu S
authors.initials: SS
authors.lastname: Thomas
authors.forename: Jason
authors.initials: J
authors.lastname: Han
authors.forename: Kerry A
authors.initials: KA
authors.lastname: Morrison
authors.forename: Sophie
authors.initials: S
authors.lastname: Jones
authors.forename: Susheel
authors.initials: S
authors.lastname: Kodali
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Hahn
authors.forename: Sofia
authors.initials: S
authors.lastname: Shames
authors.forename: Melana
authors.initials: M
authors.lastname: Yuzefpolskaya
authors.forename: Paolo
authors.initials: P
authors.lastname: Colombo
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
mesh_terms: D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: aortic valve insufficiency; echocardiography; heart-assist devices