title: Predictors of survival following trans-catheter aortic valve closure for left ventricular assist device associated aortic insufficiency.
abstract: OBJECTIVE
  This study sought to assess the long-term clinical benefits and predictors of survival of trans-catheter aortic valve closure in left ventricular assist device (LVAD) patients.
  
  
  BACKGROUND
  LVADs have been shown to increase survival and quality of life in patients with end-stage heart failure. However, severe aortic insufficiency (AI) can develop in up to 50% of patients at 12 months resulting in significant morbidity and mortality. Trans-catheter treatment of LVAD associated AI has emerged as a potential alternative to surgical treatment.
  
  
  METHODS
  We conducted a retrospective analysis of all patients undergoing trans-catheter aortic valve closure using an Amplatzer Multi-Fenestrated Septal Occluder "Cribriform" device to assess potential clinical and procedural factors associated with survival. Student's t-tests were used to compare baseline patient demographics and procedural characteristics, as well as patient outcomes immediately post procedure and at 6 months. A P-value of less than 0.05 was considered statistically significant.
  
  
  RESULTS
  A total of 10 patients (70% male, median age 59 years) were included. Technical success was accomplished in 100% of patients with a 6 month survival rate of 30% (3/10). Compared with survivors, non-survivors had a higher rate of pre-procedural clinical co-morbidities, an increased likelihood of right ventricular failure, and received larger occluder devices.
  
  
  CONCLUSIONS
  Trans-catheter aortic valve closure successfully treats late severe AI in LVAD patients, however, the presence or development of right heart failure portends a worse prognosis. Further studies are needed to investigate the factors involved in the development of right ventricular failure, and potential treatment, in patients undergoing trans-catheter aortic valve closure.
authors.affiliation: Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Retzer
authors.affiliation: Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Gabriel T
authors.initials: GT
authors.lastname: Sayer
authors.affiliation: Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Savitri E
authors.initials: SE
authors.lastname: Fedson
authors.affiliation: Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Nathan
authors.affiliation: Section of Cardiothoracic Surgery, Department of Surgery, The University of Chicago, Chicago, Illinois.
authors.forename: Valluvan
authors.initials: V
authors.lastname: Jeevanandam
authors.affiliation: Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Janet
authors.initials: J
authors.lastname: Friant
authors.affiliation: Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.affiliation: Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
authors.affiliation: Section of Cardiothoracic Surgery, Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Russo
authors.affiliation: Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Atman P
authors.initials: AP
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D015897:Comorbidity; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D055989:Septal Occluder Device; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: aortic valve insufficiency; heart failure; ventricular assist device