title: Concomitant aortic valve repair with continuous-flow left ventricular assist devices: Results and implications.
abstract: OBJECTIVE
  Aortic insufficiency (AI) after continuous-flow left ventricular assist device implantation can affect patient outcomes. Central aortic valve closure (CAVC) is a strategy commonly practiced; however, its efficacy has not been extensively investigated.
  
  
  METHODS
  From March 2004 to May 2014, a total of 340 patients received a continuous-flow left ventricular assist device (89; 26.2%) as destination therapy (DT). Outcomes were compared between patients with CAVC (n = 57 [16.8%]; group A) versus without repair (n = 283 [83.2%]; group B).
  
  
  RESULTS
  Patients in group A were older, were more likely to be having DT, had a greater cardiopulmonary bypass and aortic crossclamp time, and more often received intraoperative transfusions than did patients in group B. Twenty-three (40.4%) patients in group A had significant pre-existing AI, defined as >mild AI, whereas none did in group B. Kaplan-Meier analysis revealed that freedom from significant AI was 66.7% and 59.9% at 2 years (P = .77) in groups A and B, respectively. In the DT cohort, freedom from significant AI was 78.1% and 41.8% at 2 years (P = .077). A generalized mixed-effects model demonstrated a 57% and 69% decrease in the odds of significant AI progression among repaired patients in the entire and DT cohort, respectively, after adjusting for time effect and degree of baseline pre-existing AI.
  
  
  CONCLUSIONS
  Despite pre-existing AI, the prevalence of significant AI in patients with CAVC was comparable to the AI in those without pre-existing AI/CAVC. The efficacy of this technique was more evident in DT patients. Thus, CAVC may be an effective and durable strategy, especially in patients who require lengthy device support.
authors.affiliation: Division of Cardiac, Thoracic and Vascular Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Fukuhara
authors.affiliation: Division of Cardiac, Thoracic and Vascular Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY.
authors.forename: Codruta
authors.initials: C
authors.lastname: Chiuzan
authors.affiliation: Division of Cardiac, Thoracic and Vascular Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Jiho
authors.initials: J
authors.lastname: Han
authors.affiliation: Division of Cardiac, Thoracic and Vascular Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Polanco
authors.affiliation: Division of Cardiology, Columbia University Medical Center, New York, NY.
authors.forename: Melana
authors.initials: M
authors.lastname: Yuzefpolskaya
authors.affiliation: Division of Cardiology, Columbia University Medical Center, New York, NY.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: Division of Cardiology, Columbia University Medical Center, New York, NY.
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.affiliation: Division of Cardiology, Columbia University Medical Center, New York, NY.
authors.forename: Veli K
authors.initials: VK
authors.lastname: Topkara
authors.affiliation: Division of Cardiac, Thoracic and Vascular Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kurlansky
authors.affiliation: Division of Cardiac, Thoracic and Vascular Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Division of Cardiac, Thoracic and Vascular Surgery, Columbia University Medical Center, New York, NY. Electronic address: yn33@cumc.columbia.edu.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: aortic valve; mechanical circulatory assistance; repair; transplantation—heart; valve disease