Simultaneous aortic valve replacement in left ventricular assist device recipients: Single-center experience

Dranishnikov, N.; Stepanenko, A B; Potapov, Evgenij; Dandel, Michael; Siniawski, Henryk; Weng, Y; Krabatsch, T; Hetzer, R.

doi:10.1055/s-0030-1269267

Cited by 12 publications

(27 citation statements)

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“…Despite this, AV closures have ICU/step down unit stays and hospital lengths of stay that are comparable to patients without an AV procedure. Our data demonstrating that ICU/step down unit stays are longest with an AV replacement is consistent with data demonstrating significantly prolonged ICU stays (mean: 36 days vs. 13 days, p=0.025) for INTERMACS level 1-2 patients with an AVR (9). Certainly, the fact that AVPs generally require aortic crossclamp and prolonged cardioplegic arrest may contribute to mortality, but if that were the driving factor than we would anticipate that the longer arrest times required for an AVR would confer proportionally greater risk.…”

Section: Discussionsupporting

confidence: 90%

“…Previous studies have disagreed on whether mortality after concomitant AVP increases (9, 14, 15), with some studies demonstrating either equivalent or improved survival (1, 9, 10, 16). However, the majority of reports are from single center studies with fewer than 20 varied AVPs included in their analyses.…”

Section: Discussionmentioning

confidence: 99%

“…Current strategies to address these problems include AV closure, AV repair and AV replacement, but there is little data on short-or long-term outcomes to guide management (9, 10). This study utilizes the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Database to compare outcomes for different approaches to concomitant aortic valve procedures during implantation of continuous-flow LVADs (cf-LVAD).…”

Section: Introductionmentioning

confidence: 99%

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Concomitant aortic valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: An INTERMACS database analysis

Robertson

Naftel

Myers

et al. 2015

The Journal of Heart and Lung Transplantation

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Background Management of existing aortic insufficiency (AI) and mechanical aortic valves in patients undergoing left ventricular assist device (LVAD) implantation remains controversial. Surgical options to address these issues include closure, repair or replacement of the valve. Methods Continuous flow LVAD/BiVAD patients entered into the INTERMACS database between June 2006 to December 2012 were included (n=5,344). Outcomes were compared between patients who underwent aortic valve (AV) closure (n=125), repair (n=95) and replacement (n=85). Results Among patients that underwent an aortic valve procedure, actuarial survival was significantly reduced for AV closures (63.2%) compared to AV repairs (76.8%) and replacements (71.8%, p=0.0003). Differences were greater between groups when only INTERMACS level 1-2 patients were analyzed (p=0.003). After multivariate adjustment, aortic valve closure remained a significant risk factor for mortality (HR=1.87, 95% CI=1.39-2.53, p<0.0001). At six to twelve months postoperatively, moderate to severe AI developed in 19%, 5%, 9% and 10% of patients with available echocardiography who underwent repair, closure, replacement and no intervention, respectively (p<0.0001). Competing outcomes demonstrate that at 1-year fewer patients with aortic valve closures were transplanted compared to patients with repairs/replacements (14% vs. 19%). No differences were observed between groups with respect to cause of death, re-hospitalization, right heart failure or stroke. Conclusions AV closure was associated with increased mortality when compared to repair or replacement in patients with AI that underwent LVAD insertion. The reasons for this association require further investigation. This is the largest study to date to examine concomitant AV procedures in patients undergoing LVAD insertion.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Concomitant aortic valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: An INTERMACS database analysis

Robertson

Naftel

Myers

et al. 2015

The Journal of Heart and Lung Transplantation

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“…Mitral stenosis must be managed during LVAD implantation, since the presence of the mitral valve prosthesis (biological or mechanical) is not a contraindication for LVAD implantation [10].…”

Section: Discussionmentioning

confidence: 99%

Left ventricular assist device implantation and concomitant aortic valve replacement

et al. 2019

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Introduction The implantable device for mechanical support of the left ventricular circulation (LVAD) is widely applied as a therapeutic option for survival and improvement of the quality of life in patients with the end-stage heart failure. The objective of our paper was to present the implantation of the aforementioned device together with the aortic valve replacement in the same procedure. Case outline The patient was admitted to the hospital during his terminal stage of heart failure, with ejection fraction of 18%. The ergospirometry test showed that the maximum VO 2 was 10.1 ml/kg/min. Because the medicament therapy hadn't provided adequate results, the LVAD device was implanted as a bridge until transplantation. Due to severe aortic insufficiency, the aortic valve was concomitantly replaced with bioprosthesis in order to prevent the negative effect of this valvular disease on pump work and clinical outcome. Conclusion This case report confirms that LVAD implantation with the correction of a significant aortic insufficiency is a procedure with satisfactory short-term and long-term results.

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“…The development of aortic insufficiency (AI) in patients with a continuous flow LVAD is well documented, and the prevalence of hemodynamically significant AI is higher if the patient has AI at the time of LVAD implantation . Therefore, it is often addressed concurrently by repairing or replacing the aortic valve with a bioprosthesis . We report a case of commissural fusion of a bioprosthetic aortic valve in a bridge to transplant patient treated with a continuous flow LVAD and discuss the fate of the replaced aortic valve in this group of patients and review the strategy of dealing with AI in patients requiring LVAD support.…”

mentioning

confidence: 99%

Is a Bioprosthetic Valve in the Aortic Position Desirable with a Continuous Flow LVAD?

2015

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Commissural fusion of the native aortic valve in a patient with a continuous flow left ventricular assist device (LVAD) is a known phenomenon. This may result in aortic insufficiency (AI) leading to symptomatic heart failure. In patients with AI at the time of LVAD implantation, repairing, or replacing the aortic valve is advisable. We describe a patient who had a severe dilated cardiomyopathy and moderate AI who underwent implantation of an LVAD and aortic valve replacement with a bioprosthesis that subsequently developed commissural fusion which was found at the time of heart transplantation. This case highlights the conundrum of the management of AI in patients requiring LVAD support.

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Simultaneous aortic valve replacement in left ventricular assist device recipients: Single-center experience

Cited by 12 publications

References 0 publications

Concomitant aortic valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: An INTERMACS database analysis

Concomitant aortic valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: An INTERMACS database analysis

Left ventricular assist device implantation and concomitant aortic valve replacement

Is a Bioprosthetic Valve in the Aortic Position Desirable with a Continuous Flow LVAD?

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