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. 2018 Nov;6(11):951-960.
doi: 10.1016/j.jchf.2018.07.012.

Aortic Insufficiency During Contemporary Left Ventricular Assist Device Support: Analysis of the INTERMACS Registry

Lauren K Truby  1 , A Reshad Garan  1 , Raymond C Givens  1 , Brian Wayda  1 , Koji Takeda  2 , Melana Yuzefpolskaya  1 , Paolo C Colombo  1 , Yoshifumi Naka  2 , Hiroo Takayama  2 , Veli K Topkara  3
Affiliations

Aortic Insufficiency During Contemporary Left Ventricular Assist Device Support: Analysis of the INTERMACS Registry

Lauren K Truby et al. JACC Heart Fail. 2018 Nov.

Abstract

Objectives: This study sought to evaluate the impact of moderate to severe aortic insufficiency (AI) on outcomes in patients with continuous flow left ventricular assist devices (CF-LVADs).

Background: Development of worsening AI is a common complication of prolonged CF-LVAD support and portends poor prognosis in single-center studies. Predictors of worsening AI and its impact on clinical outcomes have not been examined in a large cohort.

Methods: We conducted a retrospective analysis of patients with CF-LVAD in the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) study. Development of significant AI was defined as the first instance of at least moderate AI. Primary outcomes of interest were survival after development of significant AI and time to adverse events, including device complications and rehospitalizations.

Results: Among 10,603 eligible patients, 1,399 patients on CF-LVAD support developed moderate to severe AI. Prevalence of significant AI progressively increased over time. Predictors of worsening AI included older age, female sex, smaller body mass index, mild pre-implantation AI, and destination therapy strategy. Moderate to severe AI was associated with significantly higher left ventricular end-diastolic diameter, reduced cardiac output, and higher levels of brain natriuretic peptide. Significant AI was associated with higher rates of rehospitalization (32.1% vs. 26.6%, respectively, at 2 years; p = 0.015) and mortality (77.2% vs. 71.4%, respectively, at 2 years; p = 0.005), conditional upon survival to 1 year.

Conclusions: Development of moderate to severe AI has a negative impact on hemodynamics, hospitalizations, and survival on CF-LVAD support. Pre- and post-implantation management strategies should be developed to prevent and treat this complication.

Keywords: aortic insufficiency; left ventricular assist device; mechanical circulatory support.

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Figures

Figure 1:
Figure 1:
Patient Population
Figure 2:
Figure 2:
A) Natural History of Worsening AI on CF-LVAD Support B) Kaplan Meier Estimates: Freedom From Moderate - Severe AI on CF-LVAD Support
Figure 3:
Figure 3:
Cross-Sectional Comparison of the Prevalence of Indices of Left Ventricular Remodeling Based Upon AI Status A) Left Ventricular End Diastolic Diameter B) Pro-BNP C) Moderate to Severe Mitral Regurgitation D) Systolic Blood Pressure E) Cardiac Output
Figure 4:
Figure 4:
Kaplan Meier Survival Estimates for On-Device Survival A) Episode Splitting at the Time of Moderate - Severe AI Development B) Conditional Survival to 2-Years Based Upon On-Device AI Status At 1-Year
Figure 5:
Figure 5:
Freedom From Device Complications Conditional Upon Survival to 1-Year A) Rehospitalization B) Bleeding Event C) Cardiac Arrhythmia D) Stroke
See this image and copyright information in PMC

Comment in

References

    1. Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Myers SL, Miller MA, Baldwin JT and Young JB. Seventh INTERMACS annual report: 15,000 patients and counting. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2015;34:1495–504. - PubMed
    1. Jorde UP, Uriel N, Nahumi N, Bejar D, Gonzalez-Costello J, Thomas SS, Han J, Morrison KA, Jones S, Kodali S, Hahn RT, Shames S, Yuzefpolskaya M, Colombo P, Takayama H and Naka Y. Prevalence, significance, and management of aortic insufficiency in continuous flow left ventricular assist device recipients. Circulation Heart failure. 2014;7:310–9. - PubMed
    1. Pak SW, Uriel N, Takayama H, Cappleman S, Song R, Colombo PC, Charles S, Mancini D, Gillam L, Naka Y and Jorde UP. Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2010;29:1172–6. - PubMed
    1. Soleimani B, Haouzi A, Manoskey A, Stephenson ER, El-Banayosy A and Pae WE. Development of aortic insufficiency in patients supported with continuous flow left ventricular assist devices. ASAIO journal. 2012;58:326–9. - PubMed
    1. Holley CT, Fitzpatrick M, Roy SS, Alraies MC, Cogswell R, Souslian L, Eckman P and John R. Aortic insufficiency in continuous-flow left ventricular assist device support patients is common but does not impact long-term mortality. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2017;36:91–96. - PubMed

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