Open AccessModerate Aortic Insufficiency with a Left Ventricular Assist Device Portends a Worse Long-Term Survival
Author(s) -
Bryan Auvil,
Jennifer J. Chung,
Alyse Ameer,
Jason J. Han,
Mark R. Helmers,
Edo Y. Birati,
Michael A. Acker,
Pavan Atluri
Publication year - 2019
Publication title -
asaio journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.961
H-Index - 66
eISSN - 1538-943X
pISSN - 1058-2916
DOI - 10.1097/mat.0000000000001071
Subject(s) - medicine , ventricular assist device , clinical endpoint , heart failure , cardiology , incidence (geometry) , population , destination therapy , retrospective cohort study , randomized controlled trial , physics , environmental health , optics
The development of aortic insufficiency (AI) is known to be associated with prolonged left ventricular assist device (LVAD) support, but its overall significance with regards to long-term outcomes is unclear. This uncertainty translates to a lack of consensus regarding the management of AI in this patient population-an increasingly pertinent question as more patients are placed on LVAD support as destination therapy. A retrospective review of a single, high-volume institution was performed to assess outcomes in patients who received a HeartMate II or HeartWare (LVAD) between 2008 and 2018. Patients were stratified by AI severity at 6 months, and those with LVAD support of less than 6 months were excluded. The primary endpoint was 2 year mortality, and secondary endpoints were right heart failure and functional exercise capacity. At 6 month follow-up 111, 92, and 18 patients had no (0), mild (1), and moderate (2) AI, respectively. Moderate AI was a significant predictor of 2 year mortality in a multivariable model (p = 0.024). Functional exercise capacity (measured by 6 minute walk test) and incidence of right heart failure at 1 year were not significantly different between groups (P = 0.1421; P = 0.2189). In conclusion, moderate AI at 6 months post-LVAD implant is associated with worse long-term mortality. More aggressive management strategies targeting AI development in long-term LVAD patients may be warranted.