title: Opening of native aortic valve accomplished after left ventricular assist device implantation in patients with insufficient preoperative Beta-blocker treatment.
abstract: Although we recently demonstrated that opening of a native aortic valve (AV) after left ventricular assist device (LVAD) implantation is a sufficient condition to prevent development of aortic insufficiency (AI), its preoperative predictors remain unknown. Data were obtained from 58 patients who had been treated with continuous flow LVAD for ≥ 6 months at our institute between 2006 and 2014. Opening of native AV was accomplished in 21 patients (36%) at postoperative 6 months. Uni/Multivariate logistic regression analyses demonstrated that a preoperative lower cumulative dose of β-blocker was the only independent predictor for postoperative opening of native AV (P = 0.020, OR 0.905) at the cutoff level of 4.5g (equivalent dose of carvedilol), calculated by an ROC analysis. Prevalence of native AV opening was increased gradually along with improvement of LV ejection fraction only in patients with preoperative insufficient β-blocker treatment during postoperative 6 months (P < 0.05 for both). Patients with opening of native AV had higher exercise capacity and a lower re-admission rate than those with closed native AV during 2-year LVAD support (5% versus 44%, P < 0.05). Opening of native AV during LVAD support is profoundly associated with LV reverse remodeling especially in patients with insufficient preoperative β-blocker exposure probably due to their better responsiveness to combination therapy with β-blocker and LVAD. Patients who accomplished native AV opening can enjoy better exercise performance and avoid re-admission due to cardiovascular events.
authors.affiliation: Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo.
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Imamura
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nitta
authors.forename: Toshiro
authors.initials: T
authors.lastname: Inaba
authors.forename: Hisataka
authors.initials: H
authors.lastname: Maki
authors.forename: Masaru
authors.initials: M
authors.lastname: Hatano
authors.forename: Osamu
authors.initials: O
authors.lastname: Kinoshita
authors.forename: Kan
authors.initials: K
authors.lastname: Nawata
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D001021:Aortic Valve / Q000502:physiology*; D001022:Aortic Valve Insufficiency / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D005544:Forecasting; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D057234:Preoperative Period; D019919:Prosthesis Implantation; D012044:Regression Analysis; D012189:Retrospective Studies; D013318:Stroke Volume; D020257:Ventricular Remodeling / Q000502:physiology
chemical_list: D000319:Adrenergic beta-Antagonists