Management of a mechanical aortic valve during left ventricular assist device implantation in a previously replaced aortic root

Abstract

The use of left ventricular assist device (LVAD) in patients with mechanical aortic valves may result in thromboembolic events due to blood stasis around the valve and intermittent valve opening. Mechanical aortic valves encountered during LVAD implantation are managed by replacement with a tissue valve, or closure of the valve with a patch. Closure of the valve carries the risk of sudden death in cases of LVAD stoppage. Replacing the whole mechanical valve conduit is time consuming and carries a significant risk of bleeding and right ventricular (RV) failure. We describe an alternative technique of replacing a mechanical aortic valve by breaking its inner leaflets and sewing a tissue valve on top of the mechanical valve ring.

Left Ventricular Assist Device Implantation combined with direct transaortic transcatheter valve-in-annular stent implantation after rescue mechanical Bentall procedure, A case report.

“…At the same time, taking into consideration the high risk of thrombosis, mechanical prosthesis should be replaced with a biological prosthesis [6,9]. Complete replacement of the aortic root takes a long time, especially under conditions of reoperation period, which can signi cantly aggravate right ventricular failure and increase hospital mortality in such category of patients [1,7,8]. The advantage of our procedure in this case report is a signi cant reduction of ischemia time and the avoidance of such an extensive reoperation period as an aortic root replacement.…”

“…A preexisting mechanical aortic valve is thought to be a thrombogenic risk factor after LVAD implantation. Usually mechanical aortic valves encountered during LVAD implantation are managed by replacement with a tissue valve or closure of the valve together with a patch [1,4,5]. This report illustrates a case of a direct transaortic transcatheter valve-in-valve implantation into a mechanical aortic valve prosthesis during LVAD implantation.…”

Aortic valve disorders and left ventricular assist devices

“…Closure of mechanical AV is technically feasible but is associated with poorer outcomes, renders the patient completely LVAD dependent, and does not permit LV recovery, and is therefore not recommended as a first line therapy. Another technique recently reported involves breaking the inner leaflets of the mechanical AV and sewing a bioprosthetic valve on top of the mechanical valve ring (77).…”

Left Ventricular Assist Devices: A Primer For the General Cardiologist

“…Patients who have a previously placed mechanical valve should undergo replacement with a bioprosthetic valve 33 because of higher rates of thromboembolic events in mechanical valves secondary to blood stasis around the valve and intermittent valve opening. 34 It is important to note that patients who have undergone oversewing of the aortic valve or patch closure are completely dependent on their LVAD for cardiac output and are at risk for sudden death in the setting of LVAD dysfunction.…”