Valvular heart disease in patients supported with left ventricular assist devices.
Patients with advanced HF and coexisting VHD who undergo LVAD implantation constitute a growing population and pose unique challenges in clinical and surgical management. Contemporary continuous-flow LVADs alter blood flow dynamics and cardiovascular physiology and can induce progression of preexisting VHD or lead to de novo VHD. Although we have defined our recommendations for treatment options (Table 2), continued changes to device technology, patient selection, and surgical techniques will undoubtedly lead to further changes in practice. Finally, the rapid growth in the field of mechanical circulatory support necessitates collaborative multicenter approaches to study the impact of these practice changes in the form of prospective randomized trials.
School of Medicine, Division of Cardiology, and Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC.
Teresa S
TS
Wang
Adrian F
AF
Hernandez
G Michael
GM
Felker
Carmelo A
CA
Milano
Joseph G
JG
Rogers
Chetan B
CB
Patel
D001021:Aortic Valve / Q000503:physiopathology; D019468:Disease Management; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008943:Mitral Valve / Q000503:physiopathology; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*
advanced heart failure; mechanical circulatory support; valvular heart disease