title: Opening of Aortic Valve During Exercise Is Key to Preventing Development of Aortic Insufficiency During Ventricular Assist Device Treatment.
abstract: Although we previously demonstrated that opening of the native aortic valve (AV) at rest prevents development of aortic insufficiency (AI) during continuous-flow (CF) left ventricular assist device (LVAD) support, the clinical impact of native AV opening during exercise remained unknown. We enrolled 37 patients with a closed native AV at rest 3 months after CF LVAD implantation and followed them from 2006 to 2014. Seven patients (19%) who achieved opening of the native AV during cardiopulmonary exercise testing at 3 months (opening AV group) had higher exercise tolerability and improved left ventricular contractility during exercise compared with those with a closed native AV (closed AV group) (p < 0.05 for all). The opening group experienced no AI at 6 months and had a higher readmission-free rate because of cardiovascular events compared with the closed group during the 2 years study period (100% vs. 56%, p = 0.005). Among those with a closed AV, use of the centrifugal pump was a significant predictor of AI-free status (p < 0.05; odds ratio, 5.400). In conclusion, opening of the native AV during exercise and centrifugal pump use were key to preventing the development of AI. Aggressive cardiac rehabilitation may have a prophylactic impact on development of AI during CF LVAD treatment.
authors.affiliation: From the *Department of Therapeutic Strategy for Heart Failure, †Department of Cardiovascular Medicine, and ‡Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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: Masaru
authors.initials: M
authors.lastname: Hatano
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000503:physiopathology*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged