Medium-term outcomes of concomitant aortic valve repair in patients with continuous-flow left ventricular assist device.

Overview

abstract

OBJECTIVE: To analyze the development of aortic insufficiency in patients who received central aortic valve repair when undergoing continuous-flow left ventricular assist device implantation. METHODS: We conducted a retrospective review of patients who underwent implantation with HeartMate II or 3 (Abbott Laboratories) between 2004 and 2022. Ninety-four patients were excluded from analysis for history of aortic valve procedures, a bicuspid aortic valve, baseline trace aortic insufficiency, or other concomitant aortic valve procedure. Patients who had mild or greater aortic insufficiency had concomitant aortic valve repair. Clinical characteristics, serial echocardiograms, and outcomes were determined. RESULTS: Of the 656 patients who underwent HeartMate II or 3 implantation, 105 patients (59 HeartMate II and 46 HeartMate 3) met study criteria. Median age was 68 years (60-74 years), 91.4% (n = 96) were male, 54.4% (n = 56) were White, and 68.6% (n = 72) received support as destination therapy. Preoperative aortic insufficiency degree was 54.3% (n = 57) mild, 23.8% (n = 25) mild-to-moderate, 20.0% (n = 21) moderate, 1.0% (n = 1) moderate-to-severe, and 1.0% (n = 1) severe. In hospital mortality was 5.7% (n = 6). Freedom from moderate or greater aortic insufficiency was 96.4% (95% confidence interval [CI], 92.5%-100%), 93.3% (95% CI, 87.6%-99.2%), and 91.0% (95% CI, 84.1%-98.5%) at 1-year, 2-year, and 3-year postimplantation, respectively. One patient who received a HeartMate II experienced severe aortic insufficiency and was treated with a heart transplant. Three-year survival was 63.4% (95% CI, 52.9%-75.9%). CONCLUSIONS: Central aortic valve repair may be an effective technique to mitigate aortic insufficiency in HeartMate II and 3. A larger cohort study with longer duration of follow-up is warranted to further investigate the clinical effect.