Influence of aortic valve opening in patients with aortic insufficiency after left ventricular assist device implantation.

Objectives: Aortic valve insufficiency (AI) following left ventricular assist device (LVAD) implantation can potentially limit the success of mechanical circulatory support. We examined the prevalence of significant AI in the new generation of LVADs and analysed the role of aortic valve opening in the development of AI in these patients.

Methods: Currently, 102 patients that received a continuous flow LVAD (cf-LVAD) between July 2009 and December 2013 are being treated in our outpatient clinic with an HeartWare ventricular assist device (HVDA) (n = 77) or HeartMate II (HMII, n = 25) and were included and analysed in a retrospective study. The mean age of the 12 female and 90 male patients was 54 ± 12 years. Ischaemic cardiomyopathy was diagnosed in 40% of patients. Echocardiographic measurements were reviewed before and after implantation. AI was considered significant if it was more than mild.

Results: Mean LVAD support duration was 572 ± 437 days. Significant AI was found in 32 patients (31.4%). De novo AI occurred in mean after 183 ± 246 days of support. One patient presented severe AI and received an aortic valve replacement. A permanently closed aortic valve correlates with a greater prevalence of AI when compared with intermittent or complete opening of aortic valve (P = 0.004). Aetiology of the cardiomyopathy and the type of device had no influence on the development of AI. Smaller left ventricle end-diastolic diameter and lower body surface area were significantly associated with the development of aortic insufficiency in our cohort.

Conclusion: Aortic insufficiency has a high prevalence following assist device continuous flow support. Echocardiographic parameters are an integral part of ambulatory care of these patients and can guide the optimal setting for LVAD. An aortic valve that does not open should be avoided in order to prevent AI. Patients with HMII or HVAD did not show any differences terms of the prevalence of aortic insufficiency prevalence.