The Development of Aortic Insufficiency in Left Ventricular Assist Device-Supported Patients

Background— Bleeding is an important cause of morbidity and mortality in patients with continuous-flow left ventricular assist devices (LVADs). Reduced pulsatility has been implicated as a contributing cause. The aim of this study was to assess the effects of different degrees of pulsatility on the incidence of nonsurgical bleeding. Methods and Results— The Utah Transplantation Affiliated Hospitals (U.T.A.H.) heart failure and transplant program databases were queried for patients with end-stage heart failure who required support with the continuous-flow LVAD HeartMate II (Thoratec Corp, Pleasanton, CA) between 2004 and 2012. Pulsatility was evaluated by means of the LVAD parameter pulsatility index (PI) and by the echocardiographic assessment of aortic valve opening during the first 3 months of LVAD support. PI was analyzed as a continuous variable and also stratified according to tertiles of all the PI measurements during the study period (low PI: <4.6, intermediate PI: 4.6–5.2, and high PI: >5.2). Major nonsurgical bleeding associated with a decrease in hemoglobin ≥2 g/dL (in the absence of hemolysis) was the primary end point. A total of 134 patients (median age of 60 [interquartile range: 49–68] years, 78% men) were included. Major bleeding occurred in 33 (25%) patients (70% gastrointestinal, 21% epistaxis, 3% genitourinary, and 6% intracranial). In multivariable analysis, PI examined either as a categorical variable, low versus high PI (hazard ratio, 4.06; 95% confidence interval, 1.35–12.21; P =0.04), or as a continuous variable (hazard ratio, 0.60; 95% confidence interval, 0.40–0.92; P =0.02) was associated with an increased risk of bleeding. Conclusions— Reduced pulsatility in patients supported with the continuous-flow LVAD HeartMate II is associated with an increased risk of nonsurgical bleeding, as evaluated by PI.

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“…It was graded as full opening, intermittent opening (1-2 openings in 3 LV systoles), or full closure during 3 LV systoles. 22 …”

Section: Echocardiographic Evaluationmentioning

confidence: 99%

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

Wever-Pinzon

Selzman

Drakos

et al. 2013

Circ: Heart Failure

214

111

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“…While the prevalence of AI remains variable in the literature, any design modifications that can attenuate the development of aortic valve fusion would be beneficial (7). It is possible that HM3 pulsatility permits intermittent aortic valve opening, thereby preventing cusp fusion and the subsequent development of aortic insufficiency.…”

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confidence: 99%

HeartMate 3—a “Step” in the right direction

Alvarez

Rao

2017

J. Thorac. Dis.

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“…13,14 To minimize the emotional complexities inherent in "destination to nowhere" situations, Bramstedt 15 hemodynamic compromise. 8 The prevalence rate associated with development of aortic insufficiency after insertion of a Heartmate II is approximately 14%. 9 From postoperative days 3 to 10, the patient became unresponsive to diuretic therapy and could not tolerate weaning trials because of pulmonary edema.…”

Section: Authorsmentioning

confidence: 99%

Destination to Nowhere: A New Look at Aggressive Treatment for Heart Failure—A Case Study

O’Neill

Kazer

2014

Critical Care Nurse

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Approximately 5.7 million people in the United States experience heart failure, and about 670 000 new cases are diagnosed annually. Patients who are ineligible for heart transplant may benefit from a left ventricular assist device. These devices have provided patients with an increased life span, but eventually patients die of the underlying heart disease. This case study illustrates the appropriate use of palliative care teams to address preparedness planning and help decrease moral distress among nursing staff. (Critical Care Nurse. 2014; 34[2]:47–56)

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The Development of Aortic Insufficiency in Left Ventricular Assist Device-Supported Patients

Abstract: Background-Aortic insufficiency (AI) following left ventricular assist device (LVAD) placement can affect device performance. The aim of this study was to examine AI development following LVAD implantation. Methods and Results-Echocardiograms

Cited by 320 publications

References 15 publications

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

HeartMate 3—a “Step” in the right direction

Destination to Nowhere: A New Look at Aggressive Treatment for Heart Failure—A Case Study

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