Can Intraoperative Transesophageal Echocardiography Predict Postoperative Aortic Insufficiency in Patients Receiving Implantable Left Ventricular Assist Devices?
OBJECTIVE
Aortic insufficiency (AI) develops in 25% of patients after left ventricular assist device (LVAD) insertion. The objective of this study was to evaluate the occurrence of new-onset AI upon initiation of cardiopulmonary bypass (CPB) required for LVAD insertion and the potential ability of this new-onset AI to predict development of post-LVAD insertion AI.


METHODS
Forty-one patients undergoing LVAD insertion were studied. Intraoperative transesophageal echocardiography (TEE) evaluation was performed at baseline (post-induction, pre-sternotomy), 5 minutes after CPB initiation, and post-chest closure. Patients were followed up postoperatively for development of AI.


METHODS
Single university hospital.


METHODS
Patients undergoing elective LVAD insertion.


METHODS
None.


RESULTS
At baseline, 35 patients exhibited none-trace AI, 4 exhibited mild AI, 2 exhibited moderate AI, and none exhibited severe AI. After initiation of CPB, 34 patients exhibited no change in degree of AI yet 7 exhibited an increase in AI severity. However, all 7 patients exhibited no change in degree of AI at chest closure and one exhibited a decrease in AI severity. Four patients developed at least moderate AI during the postoperative period (range 3-8 months). However, only one of these patients exhibited an increase in AI severity after initiation of CPB for LVAD insertion. No significant changes in aortic root measurements were observed during the entire intraoperative period (within patients nor between patients with/without development of at least moderate postoperative AI).


CONCLUSIONS
One in 5 patients undergoing LVAD insertion will demonstrate an increase in AI severity at CPB initiation without changes in aortic root measurements. None of the information obtained from intraoperative TEE seemed to predict development of at least moderate postoperative AI.
Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL.
Suzanne E
SE
Kellman
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Andrew J
AJ
Feider
Department of Cardiac and Thoracic Surgery, The University of Chicago, Chicago, IL.
Valluvan
V
Jeevanandam
Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL. Electronic address: mchaney@dacc.uchicago.edu.
Mark A
MA
Chaney
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies
aortic insufficiency; left ventricular assist device