Aortic valve closure associated with HeartMate left ventricular device support: Technical considerations and long-term results

Adamson, Robert; Dembitsky, Walter P.; Baradarian, Sam; Chammas, J.; May‐Newman, Karen; Chillcott, Suzanne; Stahovich, Marcia; McCalmont, Vicki; Ortiz, K.; Hoagland, P.; Jaski, Brian E.

doi:10.1016/j.healun.2010.11.007

Cited by 80 publications

(62 citation statements)

References 21 publications

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“…6 We first noticed that de novo development of AI was common in 2010 and, based on the belief that AI is progressive 3,7 and can lead to clinical HF, we have since routinely placed approximation stitches as described by Park et al 5 on valves with mild or more AI at the time of implantation. In addition, we have aimed to facilitate AV opening by performing a speed ramp study at the time of discharge in newly implanted patients since 2011.…”

Section: Clinical Perspective On P 319mentioning

confidence: 99%

Prevalence, Significance, and Management of Aortic Insufficiency in Continuous Flow Left Ventricular Assist Device Recipients

Jorde

Uriel

Nahumi

et al. 2014

Circ: Heart Failure

189

170

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Background-Aortic insufficiency (AI) is increasingly recognized as a complication of continuous flow left ventricularassist device support; however, its long-term prevalence, clinical significance, and efficacy of potential interventions are not well known. Methods and Results-We studied the prevalence and management of AI in 232 patients with continuous flow left ventricular assist device at our institution. Patients with aortic valve (AV) surgery before left ventricular assist device implantation were excluded from analysis. To examine the prevalence of de novo AI, patients without preoperative AI were divided into a retrospective and a prospective cohort based on whether a dedicated speed optimization study had been performed at the time of discharge. Forty-three patients underwent AV repair at the time of implant, and 3 subsequently developed greater than mild AI. In patients without surgical AV manipulation and no AI at the time of implant, Kaplan-Meier analysis revealed that freedom from greater than mild de novo AI at 1 year was 77.6±4.2%, and that at least moderate AI is expected to develop in 37.6±13.3% after 3 years. Nonopening of the AV was strongly associated with de novo AI development in patients without prospective discharge speed optimization. Seven of 21 patients with at least moderate AI developed symptomatic heart failure requiring surgical intervention. Conclusions-AI is common in patients with continuous flow left ventricular assist devices and may lead to clinical decompensation requiring surgical correction. The prevalence of AI is substantially less in patients whose AV opens, and optimized loading conditions may reduce AI prevalence in those patients in whom AV opening cannot be achieved.(Circ Heart Fail. 2014;7:310-319.)

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Section: Clinical Perspective On P 319mentioning

confidence: 99%

Prevalence, Significance, and Management of Aortic Insufficiency in Continuous Flow Left Ventricular Assist Device Recipients

Jorde

Uriel

Nahumi

et al. 2014

Circ: Heart Failure

189

170

View full text Add to dashboard Cite

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“…Several options exist, each with its own advantages and disadvantages. Supporters of valve procedures aimed at closing the ventricular outfl ow with either patch coverage of the valve or leafl et closure suggest that these approaches may theoretically decrease the risk of pump, aortic valve, or subaortic valve thrombus formation by directing fl ow entirely through the pump (5,9). Concerns raised by this approach include the mandatory dependence on the pump, which, if it were to malfunction, would potentially be lethal if the ventricle had not recovered to accommodate a high regurgitant backfl ow.…”

Section: Discussionmentioning

confidence: 99%

Replacement of the Aortic Valve with a Bioprosthesis at the Time of Continuous Flow Ventricular Assist Device Implantation for Preexisting Aortic Valve Dysfunction

Lima¹,

Chamogeorgakis²,

Mountis³

et al. 2015

Baylor University Medical Center Proceedings

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Left ventricular assist device (LVAD) implantation has become a mainstay of therapy for advanced heart failure patients who are either ineligible for, or awaiting, cardiac transplantation. Controversy remains over the optimal therapeutic strategy for preexisting aortic valvular dysfunction in these patients at the time of LVAD implant. In patients with moderate to severe aortic regurgitation, surgical approaches are center specific and range from variable leaflet closure techniques to concomitant aortic valve replacement (AVR) with a bioprosthesis. In the present study, we retrospectively analyzed our outcomes in patients who underwent simultaneous AVR and LVAD implantation secondary to antecedent aortic valve pathology. Between January 2004 and June 2010, 144 patients underwent LVAD implantation at a single institution. Of these, 7 patients (4.8%) required concomitant AVR. Five of the 7 patients (71%) survived to hospital discharge and suffered no adverse events in the perioperative period. One-year survival for the discharged patients was 80%, and no prosthetic valve-related adverse events were observed in long-term follow-up. Given our experience, we conclude that bioprosthetic AVR is a plausible alternative for end-stage heart failure patients at the time of LVAD implantation. C ontinuous fl ow pump technology has revolutionized long-term ventricular assist device therapy. Results from the HeartMate II trial show a considerable improvement in both survival and quality of life in recipients of this technology (1, 2). A proportion of these patients have associated aortic regurgitation (AR) that if left untreated may progress and impact the eff ectiveness of the pump by limiting forward fl ow (3). Th ere are several methods of managing AR at the time of left ventricular assist device (LVAD) implantation. Each has its own merits and fl aws. Techniques include patch closure of the outfl ow tract (4), primary aortic cuspal closure with felt strips (5), coaptation stitching of the valve cusps (6), and aortic valve replacement (7). Since our initial experience with the HeartMate II device, we have treated patients with signifi cant AR at the time of HeartMate II implantation by replacing the aortic valve with a bioprosthesis. Th is report describes the outcomes associated with this approach. METHODSA retrospective review of end-stage heart failure patients who had undergone LVAD implantation with the HeartMate II continuous fl ow pump with concomitant aortic valve replacement at a single institution was conducted. Etiology of heart failure encountered in this study included ischemic and valvular cardiomyopathies. Th e latter was defi ned as end-stage heart failure secondary to untreated aortic or mitral valve disease. Medical records provided demographic and echocardiographic information as well as short-and long-term outcomes. Th is study was conducted with the approval of the institutional review board of the Cleveland Clinic.All procedures were performed through a full median sternotomy. Aortic valve replacements...

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“…16 LV outflow tract closure is a definitive strategy for treating preexisting AI while circumventing challenges associated with an AV prosthesis, and multiple methods have been described. 14,[17][18][19] The Park stitch is a simple coaptation stitch placed at the central portion of the 3 aortic cusps. Bryant et al 14 sutured the commissures either centrally with a single buttressed stitch or along the full length of noncoaptation.…”

Section: Aortic Insufficiencymentioning

confidence: 99%

“…Bryant et al 14 sutured the commissures either centrally with a single buttressed stitch or along the full length of noncoaptation. Adamson et al 18 describe an alternative method using felt strips along each leaflet that are anchored to the aortic wall. Suture repair of the AV is simple, requires a shorter period of cardioplegic arrest, and may be associated with reduced thrombosis and embolism compared with AV replacement.…”

Section: Aortic Insufficiencymentioning

confidence: 99%

Valvular Heart Disease in Patients Supported With Left Ventricular Assist Devices

Wang

Hernandez

Felker

et al. 2014

Circ: Heart Failure

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Aortic valve closure associated with HeartMate left ventricular device support: Technical considerations and long-term results

Cited by 80 publications

References 21 publications

Prevalence, Significance, and Management of Aortic Insufficiency in Continuous Flow Left Ventricular Assist Device Recipients

Prevalence, Significance, and Management of Aortic Insufficiency in Continuous Flow Left Ventricular Assist Device Recipients

Replacement of the Aortic Valve with a Bioprosthesis at the Time of Continuous Flow Ventricular Assist Device Implantation for Preexisting Aortic Valve Dysfunction

Valvular Heart Disease in Patients Supported With Left Ventricular Assist Devices

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