title: Development of de novo aortic valve incompetence in patients with the continuous-flow HeartWare ventricular assist device.
abstract: BACKGROUND
  In this study we investigated the development of aortic incompetence (AI) and change in aortic root and left ventricular dimensions after implantation of the continuous-flow HeartWare ventricular assist device (HVAD) in our adult patient cohort.
  
  
  METHODS
  A retrospective analysis of serial echocardiograms was performed on patients implanted with an HVAD between July 2009 and July 2013. Data from echocardiograms performed before and at 1 and 2 years (±3 months) were analyzed. Patients with native aortic valves (AoVs) with no previous intervention and HVAD in situ for ≥6 months were included.
  
  
  RESULTS
  A total of 73 HVADs in 71 patients with a mean duration of support of 624 ± 359 days were included in our study. One patient developed moderate AI at 1 year (1.9%). Mild or greater AI was more likely in those with a closed or intermittently opening AoV at 1 year (p = 0.005). Aortic annulus dimensions increased significantly at 1 and 2 years, regardless of extent of AI. At 2 years, in those with mild or worse AI, the sinuses of Valsalva were also larger (p = 0.002). Left ventricular end-diastolic dimension (LVEDD) was significantly reduced in those with no or trace AI at 1 and 2 years (p = 0.012 and p = 0.008, respectively), but remained unchanged in those with AI at both time-points.
  
  
  CONCLUSIONS
  The development of more than mild AI is rare in HVAD patients at our center. When encountered, it is more common with a closed AoV. Dilation of the aortic annulus, and root dilation in those with mild or more AI, is seen with HVAD support over time.
authors.affiliation: Departments of Cardiology.
authors.forename: Sai
authors.initials: S
authors.lastname: Bhagra
authors.affiliation: Departments of Cardiology.
authors.forename: Catriona
authors.initials: C
authors.lastname: Bhagra
authors.affiliation: Cardiothoracic Surgery.
authors.forename: Faruk
authors.initials: F
authors.lastname: Özalp
authors.affiliation: Cardiothoracic Surgery; Cardiopulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Tanveer
authors.initials: T
authors.lastname: Butt
authors.affiliation: Cardiothoracic Surgery; Cardiopulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: B C
authors.initials: BC
authors.lastname: Ramesh
authors.affiliation: Cardiothoracic Surgery; Cardiopulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Gareth
authors.initials: G
authors.lastname: Parry
authors.affiliation: Cardiothoracic Surgery.
authors.forename: Chandrika
authors.initials: C
authors.lastname: Roysam
authors.affiliation: Cardiothoracic Surgery.
authors.forename: Andrew
authors.initials: A
authors.lastname: Woods
authors.affiliation: Cardiothoracic Surgery.
authors.forename: Nicola
authors.initials: N
authors.lastname: Robinson-Smith
authors.affiliation: Cardiothoracic Surgery; Cardiopulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Wrightson
authors.affiliation: Departments of Cardiology; Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Guy A
authors.initials: GA
authors.lastname: MacGowan
authors.affiliation: Cardiothoracic Surgery; Cardiopulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne, UK. Electronic address: stephan.schueler@nuth.nhs.uk.
authors.forename: Stephan
authors.initials: S
authors.lastname: Schueler
mesh_terms: D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology*; D004452:Echocardiography; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies
keywords: HVAD; HeartWare; VAD; aortic incompetence; aortic regurgitation; aortic root; echocardiogram