Hemodynamic changes and mid-term results of surgical correction of de novo aortic valve insufficiency after left ventricular assist device implantation

Abstract

Severe aortic insufficiency (AI) is a common complication associated with prolonged continuous-flow left ventricular assist device (CF-LVAD) therapy. This study aimed to investigate the clinical outcomes after surgical correction of de novo AI after LVAD implantation. A total of 190 patients underwent CF-LVAD implantation between January 2013 and June 2022. Of these, 24 had trivial or no AI before LVAD implantation and developed moderate or greater de novo AI after LVAD implantation. Patients who underwent aortic valve surgery before or concomitant with LVAD surgery were excluded. Among the 24 patients, surgeries were indicated for medically refractory de novo AI in 11 patients, who were included. The primary outcome was postoperative improvement in hemodynamics as assessed by right heart catheter examination, and the secondary endpoints were 3-year survival and freedom from death and/or heart failure readmission rates. The correction of de novo AI was accomplished with aortic valve closure using a bovine pericardial patch in 10 patients and prosthetic valve replacement in one patient. Significant differences (all p < 0.01) in pre- vs. post-surgery pulmonary artery wedge pressure, cardiac index, and mixed venous blood oxygen saturation were found. The mean follow-up period after LVAD implantation was 1413 days, and the 3-year survival rate was 90.9%. Three-year freedom from postoperative moderate or greater AI rate and freedom from heart failure readmission rate were both 90.9%. Postoperative hemodynamic status and survival outcomes are favorable in patients who underwent surgical aortic valve repair de novo AI after LVAD implantation.

Keywords: Aortic insufficiency; Ventricular assisted device.