Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices

Sang Woo Pak, Nir Uriel, Hiroo Takayama, Sarah Cappleman, Robert Song, Paolo C. Colombo, Sandy Charles, Donna Mancini, Linda Gillam, Yoshifumi Naka, Ulrich P. Jorde

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Abstract

Background: Left ventricular assist devices (LVADs) are increasingly used as long-term therapy for end-stage heart failure patients. We compared the prevalence of aortic insufficiency (AI) after HeartMate II (HMII) vs HeartMate XVE (HMI) support and assessed the role of aortic root diameter and aortic valve opening in the development of AI. Method: Pre-operative and post-operative echocardiograms of 93 HMI and 73 HMII patients who received implants at our center between January 2004 and September 2009 were retrospectively reviewed. After excluding patients with prior or concurrent surgical manipulation of the aortic valve, with baseline AI, or without baseline echoes, 67 HMI and 63 HMII patients were studied. AI was deemed significant if mild to moderate or greater. Pathology reports were reviewed for 77 patients who underwent heart transplant. Results: AI developed in 4 of 67 HMI (6.0%) and in 9 of 63 HMII patients (14.3%). The median times to AI development were 48 days for HMI patients and 90 days for HMII patients. For patients who remained on device support at 6 and 12 months, freedom from AI was 94.5% and 88.9% in HMI patients and 83.6% and 75.2% in HMII patients (log rank p = 0.194). Aortic root diameters, as determined by echocardiography for the patients with AI, trended to be larger at baseline (3.43 ± 0.43 vs 3.15 ± 0.40; p = 0.067) and follow-up (3.58 ± 0.54 vs 3.29 ± 0.50; p = 0.130) compared with those who did not have AI. Aortic root circumferences were assessed directly by a pathologist in those patients who underwent transplant and were significantly larger in HMII patients who had developed AI compared with those patients who did not (8.44 ± 0.89 vs 7.36 ± 1.02 cm; p = 0.034). Lastly, AI was more common in patients whose aortic valve did not open (11 of 26 vs 1 of 14; p = 0.03). Conclusion: Aortic insufficiency occurs frequently in patients who receive continuous-flow support with a HMII LVAD, and may be associated with aortic root diameter enlargement and aortic valve opening. These findings warrant a more thorough preoperative patient evaluation and additional studies to investigate the factors, that may be associated with AI development.

Original languageEnglish (US)
Pages (from-to)1172-1176
Number of pages5
JournalJournal of Heart and Lung Transplantation
Volume29
Issue number10
DOIs
StatePublished - Oct 1 2010
Externally publishedYes

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Heart-Assist Devices
Aortic Valve
Transplants

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Pak, S. W., Uriel, N., Takayama, H., Cappleman, S., Song, R., Colombo, P. C., ... Jorde, U. P. (2010). Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices. Journal of Heart and Lung Transplantation, 29(10), 1172-1176. https://doi.org/10.1016/j.healun.2010.05.018
Pak, Sang Woo ; Uriel, Nir ; Takayama, Hiroo ; Cappleman, Sarah ; Song, Robert ; Colombo, Paolo C. ; Charles, Sandy ; Mancini, Donna ; Gillam, Linda ; Naka, Yoshifumi ; Jorde, Ulrich P. / Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices. In: Journal of Heart and Lung Transplantation. 2010 ; Vol. 29, No. 10. pp. 1172-1176.
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abstract = "Background: Left ventricular assist devices (LVADs) are increasingly used as long-term therapy for end-stage heart failure patients. We compared the prevalence of aortic insufficiency (AI) after HeartMate II (HMII) vs HeartMate XVE (HMI) support and assessed the role of aortic root diameter and aortic valve opening in the development of AI. Method: Pre-operative and post-operative echocardiograms of 93 HMI and 73 HMII patients who received implants at our center between January 2004 and September 2009 were retrospectively reviewed. After excluding patients with prior or concurrent surgical manipulation of the aortic valve, with baseline AI, or without baseline echoes, 67 HMI and 63 HMII patients were studied. AI was deemed significant if mild to moderate or greater. Pathology reports were reviewed for 77 patients who underwent heart transplant. Results: AI developed in 4 of 67 HMI (6.0{\%}) and in 9 of 63 HMII patients (14.3{\%}). The median times to AI development were 48 days for HMI patients and 90 days for HMII patients. For patients who remained on device support at 6 and 12 months, freedom from AI was 94.5{\%} and 88.9{\%} in HMI patients and 83.6{\%} and 75.2{\%} in HMII patients (log rank p = 0.194). Aortic root diameters, as determined by echocardiography for the patients with AI, trended to be larger at baseline (3.43 ± 0.43 vs 3.15 ± 0.40; p = 0.067) and follow-up (3.58 ± 0.54 vs 3.29 ± 0.50; p = 0.130) compared with those who did not have AI. Aortic root circumferences were assessed directly by a pathologist in those patients who underwent transplant and were significantly larger in HMII patients who had developed AI compared with those patients who did not (8.44 ± 0.89 vs 7.36 ± 1.02 cm; p = 0.034). Lastly, AI was more common in patients whose aortic valve did not open (11 of 26 vs 1 of 14; p = 0.03). Conclusion: Aortic insufficiency occurs frequently in patients who receive continuous-flow support with a HMII LVAD, and may be associated with aortic root diameter enlargement and aortic valve opening. These findings warrant a more thorough preoperative patient evaluation and additional studies to investigate the factors, that may be associated with AI development.",
author = "Pak, {Sang Woo} and Nir Uriel and Hiroo Takayama and Sarah Cappleman and Robert Song and Colombo, {Paolo C.} and Sandy Charles and Donna Mancini and Linda Gillam and Yoshifumi Naka and Jorde, {Ulrich P.}",
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Pak, SW, Uriel, N, Takayama, H, Cappleman, S, Song, R, Colombo, PC, Charles, S, Mancini, D, Gillam, L, Naka, Y & Jorde, UP 2010, 'Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices', Journal of Heart and Lung Transplantation, vol. 29, no. 10, pp. 1172-1176. https://doi.org/10.1016/j.healun.2010.05.018

Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices. / Pak, Sang Woo; Uriel, Nir; Takayama, Hiroo; Cappleman, Sarah; Song, Robert; Colombo, Paolo C.; Charles, Sandy; Mancini, Donna; Gillam, Linda; Naka, Yoshifumi; Jorde, Ulrich P.

In: Journal of Heart and Lung Transplantation, Vol. 29, No. 10, 01.10.2010, p. 1172-1176.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices

AU - Pak, Sang Woo

AU - Uriel, Nir

AU - Takayama, Hiroo

AU - Cappleman, Sarah

AU - Song, Robert

AU - Colombo, Paolo C.

AU - Charles, Sandy

AU - Mancini, Donna

AU - Gillam, Linda

AU - Naka, Yoshifumi

AU - Jorde, Ulrich P.

PY - 2010/10/1

Y1 - 2010/10/1

N2 - Background: Left ventricular assist devices (LVADs) are increasingly used as long-term therapy for end-stage heart failure patients. We compared the prevalence of aortic insufficiency (AI) after HeartMate II (HMII) vs HeartMate XVE (HMI) support and assessed the role of aortic root diameter and aortic valve opening in the development of AI. Method: Pre-operative and post-operative echocardiograms of 93 HMI and 73 HMII patients who received implants at our center between January 2004 and September 2009 were retrospectively reviewed. After excluding patients with prior or concurrent surgical manipulation of the aortic valve, with baseline AI, or without baseline echoes, 67 HMI and 63 HMII patients were studied. AI was deemed significant if mild to moderate or greater. Pathology reports were reviewed for 77 patients who underwent heart transplant. Results: AI developed in 4 of 67 HMI (6.0%) and in 9 of 63 HMII patients (14.3%). The median times to AI development were 48 days for HMI patients and 90 days for HMII patients. For patients who remained on device support at 6 and 12 months, freedom from AI was 94.5% and 88.9% in HMI patients and 83.6% and 75.2% in HMII patients (log rank p = 0.194). Aortic root diameters, as determined by echocardiography for the patients with AI, trended to be larger at baseline (3.43 ± 0.43 vs 3.15 ± 0.40; p = 0.067) and follow-up (3.58 ± 0.54 vs 3.29 ± 0.50; p = 0.130) compared with those who did not have AI. Aortic root circumferences were assessed directly by a pathologist in those patients who underwent transplant and were significantly larger in HMII patients who had developed AI compared with those patients who did not (8.44 ± 0.89 vs 7.36 ± 1.02 cm; p = 0.034). Lastly, AI was more common in patients whose aortic valve did not open (11 of 26 vs 1 of 14; p = 0.03). Conclusion: Aortic insufficiency occurs frequently in patients who receive continuous-flow support with a HMII LVAD, and may be associated with aortic root diameter enlargement and aortic valve opening. These findings warrant a more thorough preoperative patient evaluation and additional studies to investigate the factors, that may be associated with AI development.

AB - Background: Left ventricular assist devices (LVADs) are increasingly used as long-term therapy for end-stage heart failure patients. We compared the prevalence of aortic insufficiency (AI) after HeartMate II (HMII) vs HeartMate XVE (HMI) support and assessed the role of aortic root diameter and aortic valve opening in the development of AI. Method: Pre-operative and post-operative echocardiograms of 93 HMI and 73 HMII patients who received implants at our center between January 2004 and September 2009 were retrospectively reviewed. After excluding patients with prior or concurrent surgical manipulation of the aortic valve, with baseline AI, or without baseline echoes, 67 HMI and 63 HMII patients were studied. AI was deemed significant if mild to moderate or greater. Pathology reports were reviewed for 77 patients who underwent heart transplant. Results: AI developed in 4 of 67 HMI (6.0%) and in 9 of 63 HMII patients (14.3%). The median times to AI development were 48 days for HMI patients and 90 days for HMII patients. For patients who remained on device support at 6 and 12 months, freedom from AI was 94.5% and 88.9% in HMI patients and 83.6% and 75.2% in HMII patients (log rank p = 0.194). Aortic root diameters, as determined by echocardiography for the patients with AI, trended to be larger at baseline (3.43 ± 0.43 vs 3.15 ± 0.40; p = 0.067) and follow-up (3.58 ± 0.54 vs 3.29 ± 0.50; p = 0.130) compared with those who did not have AI. Aortic root circumferences were assessed directly by a pathologist in those patients who underwent transplant and were significantly larger in HMII patients who had developed AI compared with those patients who did not (8.44 ± 0.89 vs 7.36 ± 1.02 cm; p = 0.034). Lastly, AI was more common in patients whose aortic valve did not open (11 of 26 vs 1 of 14; p = 0.03). Conclusion: Aortic insufficiency occurs frequently in patients who receive continuous-flow support with a HMII LVAD, and may be associated with aortic root diameter enlargement and aortic valve opening. These findings warrant a more thorough preoperative patient evaluation and additional studies to investigate the factors, that may be associated with AI development.

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