Aortic insufficiency in patients with sustained left ventricular systolic dysfunction after axial flow assist device implantation.
BACKGROUND
Predicting the occurrence of aortic insufficiency (AI) during left ventricular assist device (LVAD) support has remained unsolved.


RESULTS
We enrolled 52 patients who had received continuous flow LVAD (14 axial and 38 centrifugal pumps) and who been followed for ≥6 months between Jun 2006 and Dec 2013. Native aortic valve (AV) opening was observed in 18 patients (35%) with improved LV systolic function, and none of them had AI. On multivariate logistic regression analysis preoperative shorter heart failure duration was the only independent predictor of postoperative native AV opening (P=0.042; odds ratio [OR], 0.999). Of the remaining 34 patients (65%) with closed AV, 11 had AI with enlargement of the aortic root and narrow pulse pressure. Among those with closed AV, axial pump use (n=13) was the only significant predictor of the development of AI (P=0.042; OR, 4.950). Patients with AI had lower exercise capacity and a higher readmission rate than those without AI during 2-year LVAD support (55% vs. 8%; P<0.001).


CONCLUSIONS
Native AV opening during LVAD support is profoundly associated with reversal of LV systolic function, especially in patients with preoperative shorter heart failure duration. Among those in whom the native AV remains closed, low pulsatility of axial flow pump may facilitate aortic root remodeling and post-LVAD AI development that results in worse clinical outcome.
Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo.
Teruhiko
T
Imamura
Koichiro
K
Kinugawa
Takeo
T
Fujino
Toshiro
T
Inaba
Hisataka
H
Maki
Masaru
M
Hatano
Osamu
O
Kinoshita
Kan
K
Nawata
Shunei
S
Kyo
Minoru
M
Ono
D000328:Adult; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006351:Heart Valves / Q000601:surgery; D006353:Heart-Assist Devices / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011859:Radiography; D012189:Retrospective Studies; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*
D002317:Cardiovascular Agents