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Secondary aortic valve replacement in continuous flow left ventricular assist device therapy
Author(s) -
Gyoten Takayuki,
Morshuis Michiel,
Fox Henrik,
Deutsch MarcusAndré,
HakimMeibodi Kavous,
Schramm René,
Gummert Jan F.,
Rojas Sebastian V.
Publication year - 2021
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.13906
Subject(s) - medicine , ventricular assist device , destination therapy , surgery , aortic valve replacement , regurgitation (circulation) , heart failure , context (archaeology) , aortic valve , cardiology , heart transplantation , transplantation , stenosis , paleontology , biology
The purpose of the study was to investigate the outcome of secondary surgical aortic valve replacement (sSAVR) in patients with severe aortic regurgitation (AR) in the context of ventricular assist device (VAD) therapy. From 2009 to 2020, 792 patients underwent cf‐LVAD implantation [HVAD (Medtronic, USA), n = 585, and HM 3 (Abbott, USA), n = 207]. All cf‐LVAD patients with severe AR requiring secondary AVR were enrolled in this study. A total of six patients (median, 40 years, IQR; 34‐61 years, 50% male) underwent secondary surgical aortic valve replacement (sSAVR) after cf‐LVAD implantation. Median time of previous LVAD support was 26 months (IQR: 21‐29 months). Two patients required additional tricuspid valve repair (TVR) and one patient underwent SAVR after failed TAVR. Four patients needed temporary right ventricular assist device (RVAD) with a median of 30 days (IQR; 29‐33 days). Three patients were bridged to urgent heart transplantation due to persevering right heart failure, whereas two destination therapy (DT) candidates survived without any associated complications. An additional DT patient died of pneumonia 1 month after sSAVR. Secondary surgical aortic valve replacement in ongoing LVAD patients is an advanced procedure for a complex cohort. In our series, sSAVR was safely performed and effective, but involved a high‐risk for subsequent right heart failure, requiring urgent heart transplantation. In LVAD patients with severe AR requiring treatment where TAVR is not feasible, sSAVR can be evaluated as salvage option for bridge to transplant patients or selected destination therapy candidates.