Trans-catheter closure of the native aortic valve with an Amplatzer® Occluder to treat progressive aortic regurgitation after implantation of a left-ventricular assist device

Abstract

We report on a patient with ischaemic dilated cardiomyopathy, who developed progressive regurgitation of his native aortic valve after implantation of a left-ventricular assist device (LVAD, HeartMate II). Increasing regurgitant volume led to reduced effective cardiac output and worsening of symptoms. To overcome aortic regurgitation, we successfully closed his aortic valve minimally invasively using the Amplatzer(®) P.I. Muscular VSD Occluder. This led to instant haemodynamic stabilisation. We observed significant residual regurgitation through the Occluder during the initial phase, which led temporarily to increased haemolysis and subsequently to worsening of kidney function; once the haemolysis ceased, we noted a very good interventional and clinical result at short-term follow-up.

Management of severe aortic regurgitation in a patient with cardiogenic shock using a percutaneous left ventricular assist device and transcatheter occlusion of the failed aortic valve homograft as a bridge to surgical valve replacement

“…In this case, we report the off‐label use of an Amplatzer occluder device to limit aortic regurgitation thus permitting the use of mechanical support in a patient with failing circulation. Amplatzer‐type occluder devices have been used to occlude a native aortic valve in patients with progressive aortic regurgitation in the setting of HeartMate II™ left ventricular assist device, but never before to our knowledge has one been used in an unstable patient to occlude a regurgitant aortic homograft in conjunction with a TandemHeart support device .…”

Mini Right Thoracotomy as an Approach to Aortic Valve Closure in an Assist Device Patient

“…4 Another is the use of a central stitch across the aortic valve. 7,8 Furthermore, this approach would be difficult in patients with significant aortic root dilation. Percutaneous occlusion with an Amplatzer occluder across the aortic valve has been attempted.…”

Medical Management of Patients With Continuous-Flow Left Ventricular Assist Devices

“…The combination of this high pressure gradient between the aorta and the decompressed LV on an LVAD and continuous blood flow explains, in part, why a small regurgitant orifice can lead to a large volume of regurgitant blood flow. Percutaneous closures of the AV [75–78] and transcatheter aortic valve replacements [79,80] have been reported for the management of AI, though long-term data are limited. In select cases, some patients also require surgical intervention for AV replacement or LV outflow tract closure by suturing closed the AV.…”