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)
First Online: 06 November 2013 DOI:
Cite this article as: Holtz, J. & Teuteberg, J. Curr Heart Fail Rep (2014) 11: 103. doi:10.1007/s11897-013-0172-6 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.
Keywords Aortic insufficiency Left ventricular assist device Valvular disorder End-stage heart failure Aortic valve replacement/repair Mechanical circulatory support Continuous flow References Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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