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Management of Aortic Insufficiency in the Continuous Flow Left Ventricular Assist Device Population

  • Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (AK Hasan, Section Editor)
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Abstract

With the current generation of continuous-flow (CF) left ventricular assist devices (LVADs), patients are able to be supported for longer periods of time. As a result, there has been increasing focus on long-term complications from prolonged mechanical circulatory support, such as acquired aortic insufficiency (AI). In the presence of an LVAD, AI leads to a blind circulatory loop, with a portion of LVAD output regurgitating through the aortic valve (AV) into the left ventricle and back again through the device, limiting effective forward flow and ultimately leading to organ malperfusion and increased left ventricular diastolic pressures. The AV also experiences abnormal biomechanics as a result of limited valve opening in the presence of a CF LVAD. Increased shear stress, elevated transvalvular pressure gradients, and decreased valve open time all contribute to acquired AI. The prognosis of moderate to severe AI in LVAD patients is generally poor and leads to a higher rate of AV replacement and potentially reduced survival. However, there are no evidence-based guidelines for management of this challenging population. In severe AI, experts generally advocate AV replacement or repair, while lesser degrees of AI can be managed medically and/or with adjustments in pump parameters.

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Conflict of Interest

Jonathan Holtz declares that he has no conflict of interest.

Jeffrey Teuteberg has received consulting fees/honoraria from Sunshine Heart and HeartWare; has received financial support for travel to meetings from Thoratec and HeartWare; has received compensation from Terumo for participation in review activities such as data monitoring boards, statistical analysis, and endpoint committees; and has received payment for lectures, including service on speakers bureaus, from XDx.

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  1. Heart and Vascular Institute, University of Pittsburgh Medical Center, S-553 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Jonathan Holtz

  2. Heart and Vascular Institute, University of Pittsburgh Medical Center, Scaife Hall, Suite 556, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Jeffrey Teuteberg

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Holtz, J., Teuteberg, J. Management of Aortic Insufficiency in the Continuous Flow Left Ventricular Assist Device Population. Curr Heart Fail Rep 11, 103–110 (2014). https://doi.org/10.1007/s11897-013-0172-6

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