Insufficiency of the native aortic valve and left ventricular assist system inflow valve after support with an implantable left ventricular assist system: Signs, symptoms, and concerns

Abstract

with progressive symptoms of heart failure and was listed for heart transplantation. His condition deteriorated despite institution of inotropic drug support. An echocardiogram showed global biventricular dysfunction with no aortic stenosis or insufficiency. On June 20, 2000, a TCI VE HeartMate left ventricular assist system (LVAS) (Thoratec Corporation, Pleasanton, Calif) was implanted. The patient had an uneventful postoperative course and was discharged to his home on July 23, 2000. He was doing well with LVAS rates between 70 and 80 beats/min and flows ranging between 6 and 8 L/min. Two and one-half months after implantation, he began to have mild dyspnea with his usual activities. The LVAS rates and flows were inappropriately elevated at rest (80-100 beats/min, flows 8-9 L/min). An echocardiogram showed moderate LVAS inflow valve regurgitation and mild native aortic valve insufficiency. On October 3, 2000, an orthotopic heart transplantation was performed. The LVAS inflow valve had two small linear perforations in the leaflets and partial dehiscence of two commissures. The LVAS outflow valve was intact. The aortic valve was fused along the anterior aspect of the left noncoronary commissure (Figure 1). The posterior aspect of the commissure was open. A small thrombus was present along the right lunula of the left coronary cusp of the aortic valve. Examination of the ostium of the outflow graft insertion revealed it to be situated above the right coronary cusp with the angle of the graft directed toward the left coronary cusp. The ostia of the coronary arteries were patent. No

Blood Pressure and Adverse Events During Continuous Flow Left Ventricular Assist Device Support

“…6,7 Aortic valve closure seems to play a primary role in this process, and although the pathophysiology remains unclear, it is likely as a result of an increase in the duration of the instantaneous transvalvular pressure gradient leading to pathological remodeling and commissural fusion. 8,9 Aortic root dilatation as a consequence of the elevated pressure caused by retrograde flow from the outflow cannula is also a contributing factor. 10 Appropriately, much attention has been dedicated to pump speed operation for promotion of aortic valve opening to mitigate this complication.…”

Review of Recent Results using Computational Fluid Dynamics Simulations in Patients Receiving Mechanical Assist Devices for End-Stage Heart Failure

“…23 One of the leading complications after LVAD implantation is the development and progression of aortic valve disease, especially aortic regurgitation. [24][25][26][27] Severe aortic insufficiency can lead to heart failure symptoms and may require surgical intervention to restore cardiac function. 28 The use of continuous-flow devices has been reported as an independent risk factor for developing aortic insufficiency.…”

Unforeseen Consequences of Therapy With Continuous-Flow Pumps

“…2 Although not of critical clinical importance, the regurgitation could cause accelerated pump flow and further contribute to the already limited durability of these pumps. In the wake of these clinical observations, we attempted to quantify our experience with aortic valve deformity in HM-XVE recipients by analyzing 33 cases in which autopsy specimens or post-transplant explants were available.…”