Aortic insufficiency in continuous-flow left ventricular assist device support patients is common but does not impact long-term mortality.
Aortic insufficiency (AI) is a significant long-term complication of continuous-flow left ventricular assist device (CF-LVAD) implantation. We sought to evaluate its impact on clinical outcomes and mortality in CF-LVAD recipients.



We retrospectively analyzed 237 patients implanted with HeartMate II CF-LVADs at our institution from June 2005 through June 2013. We evaluated recipients' baseline characteristics and annual echocardiograms, grading AI severity as either none, trace, mild, moderate or severe. Only moderate or severe AI was considered clinically significant. Recipients who underwent concomitant aortic valve surgery or who had undergone previous prosthetic aortic valve implantation were excluded.



Moderate or severe AI occurred in 32 (15.2%) patients. Risk factors that significantly affected the development of AI included older age at the time of implantation, female gender, longer duration of LVAD support and destination therapy designation. Freedom from moderate or severe AI was 94%, 76% and 65% of patients at 1, 3 and 5 years, respectively. Overall cohort survival based on Kaplan-Meier analysis was 78%, 59% and 42% at 1, 3 and 5 years, respectively. There was no difference in survival between recipients who developed significant AI and those who did not (log-rank test, p = 0.73).



In this large, single-institution study, the overall rate of AI was low, but increased in frequency with longer duration of LVAD support. Although AI development remains a concern for patients on long-term CF-LVAD support, AI development does not appear to impact long-term mortality.
Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Christopher T
CT
Holley
Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Megan
M
Fitzpatrick
Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, Minnesota, USA.
Samit S
SS
Roy
Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, Minnesota, USA.
M Chadi
MC
Alraies
Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, Minnesota, USA.
Rebecca
R
Cogswell
Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Laura
L
Souslian
Minneapolis Heart Institute, Minneapolis, Minnesota, USA.
Peter
P
Eckman
Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, Minnesota, USA. Electronic address: johnx008@umn.edu.
Ranjit
R
John
D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D002423:Cause of Death / Q000639:trends; D004452:Echocardiography; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
aortic insufficiency; aortic regurgitation; circulatory support device; heart failure; outcomes; surgery (complications)