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Impact of progressive aortic regurgitation on outcomes after left ventricular assist device implantation

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Abstract

Aortic regurgitation (AR) following continuous flow left ventricular assist device implantation (cf-LVAD) may adversely impact outcomes. We aimed to assess the incidence and impact of progressive AR after cf-LVAD on prognosis, biomarkers, functional capacity and echocardiographic findings. In an analysis of the PCHF-VAD database encompassing 12 European heart failure centers, patients were dichotomized according to the progression of AR following LVAD implantation. Patients with de-novo AR or AR progression (AR_1) were compared to patients without worsening AR (AR_0). Among 396 patients (mean age 53 ± 12 years, 82% male), 153 (39%) experienced progression of AR over a median of 1.4 years on LVAD support. Before LVAD implantation, AR_1 patients were less frequently diabetic, had lower body mass indices and higher baseline NT-proBNP values. Progressive AR did not adversely impact mortality (26% in both groups, HR 0.91 [95% CI 0.61–1.36]; P = 0.65). No intergroup variability was observed in NT-proBNP values and 6-minute walk test results at index hospitalization discharge and at 6-month follow-up. However, AR_1 patients were more likely to remain in NYHA class III and had worse right ventricular function at 6-month follow-up. Lack of aortic valve opening was related to de-novo or worsening AR (P < 0.001), irrespective of systolic blood pressure (P = 0.67). Patients commonly experience de-novo or worsening AR when exposed to continuous flow of contemporary LVADs. While reducing effective forward flow, worsening AR did not influence survival. However, less complete functional recovery and worse RV performance among AR_1 patients were observed. Lack of aortic valve opening was associated with progressive AR.

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Authors and Affiliations

  1. Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia

    Hrvoje Gasparovic, Mate Petricevic & Bojan Biocina

  2. Department of Cardiology, University Hospital Center Zagreb, Zagreb, Croatia

    Nina Jakus, Ivo Planinc, Daniel Lovric, Davor Milicic & Maja Cikes

  3. Division of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Jasper J. Brugts

  4. Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium

    Anne-Catherine Pouleur

  5. Pôle de Recherche Cardiovasculaire (CARD) Institut de Recherche Expérimentale et Clinique (IREC) Université Catholique de Louvain, Louvain, Belgium

    Anne-Catherine Pouleur

  6. Department of Cardiology, University Hospital Leuven, Leuven, Belgium

    Philippe Timmermans & Walter Droogne

  7. Department of Cardiac and Vascular Diseases Krakow, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland

    Pawel Rubiś & Katarzyna Holcman

  8. Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    Edvinas Gaizauskas

  9. Antwerp University Hospital, Antwerp, Belgium

    Emeline M. Van Craenenbroeck

  10. INIBIC, CIBERCV, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain

    Eduardo Barge-Caballero

  11. Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany

    Sebastian Grundmann

  12. Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy

    Stefania Paolillo

  13. Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Domenico D’Amario

  14. Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden

    Oscar Ö. Braun

  15. Department of Cardiac Surgery, University Hospital Leuven, Leuven, Belgium

    Bart Meyns

  16. Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland

    Karol Wierzbicki

  17. Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland

    Andreas J. Flammer & Frank Ruschitzka

  18. Department of Medicine, Karolinska Institute, Stockholm, Sweden

    Lars H. Lund

Authors
  1. Hrvoje Gasparovic
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  2. Nina Jakus
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  3. Jasper J. Brugts
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  4. Anne-Catherine Pouleur
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  5. Philippe Timmermans
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  6. Pawel Rubiś
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  7. Edvinas Gaizauskas
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  8. Emeline M. Van Craenenbroeck
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  9. Eduardo Barge-Caballero
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  10. Sebastian Grundmann
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  11. Stefania Paolillo
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  12. Domenico D’Amario
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  13. Oscar Ö. Braun
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  14. Bart Meyns
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  15. Walter Droogne
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  16. Karol Wierzbicki
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  17. Katarzyna Holcman
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  18. Ivo Planinc
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  19. Daniel Lovric
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  20. Andreas J. Flammer
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  21. Mate Petricevic
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  22. Bojan Biocina
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  23. Lars H. Lund
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  24. Davor Milicic
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  25. Frank Ruschitzka
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  26. Maja Cikes
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Corresponding author

Correspondence to Hrvoje Gasparovic.

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Conflict of interest

Dr. Gasparovic has nothing to disclose. Dr. Jakus reports non-financial support from Servier, personal fees from Teva Pharmaceutical Industries, personal fees from Krka, non-financial support from Abbott, personal fees from Sanofi Genzyme, outside the submitted work. Dr. Brugts reports grants and personal fees from Abbott, outside the submitted work. Dr. Pouleur reports Advisory Board/Speaker Fee for Astra-Zeneca, MSD, Bayer, Novartis, Actelion, Pfizer. Dr. Timmermans has nothing to disclose. Dr. Rubiś has nothing to disclose. Dr. Gaizauskas has nothing to disclose. Dr. Van Craenenbroeck has nothing to disclose. Dr. Barge-Caballero reports grants from ABBOT, personal fees from ABBOT, other from MEDTRONIC, outside the submitted work. Dr. Grundmann has nothing to disclose. Dr. Paolillo has nothing to disclose. Dr. D'Amario has nothing to disclose. Dr. Braun has nothing to disclose. Dr. Meyns has nothing to disclose. Dr. Droogne has nothing to disclose. Dr. Wierzbicki has nothing to disclose. Dr. Holcman has nothing to disclose. Dr. Planinc reports personal fees from Boehringer Ingelheim, personal fees from Teva Pharmaceutical Industries, personal fees and non-financial support from Novartis, personal fees and non-financial support from Pfizer, personal fees from Servier, personal fees and non-financial support from Krka, personal fees and non-financial support from Bayer, personal fees from Sandoz, personal fees from Corvia, personal fees and non-financial support from Abbott, non-financial support from Sanofi Aventis, outside the submitted work. Dr. Lovric reports personal fees and non-financial support from Astra Zeneca, personal fees and non-financial support from Boehringer Ingelheim, personal fees from Novartis, personal fees from Pliva, personal fees from Servier, personal fees from Sandoz, personal fees from Krka Pharma, personal fees and non-financial support from PharmaS, non-financial support from Pfizer, personal fees from Bayer, personal fees from Pharma Swiss, personal fees from Berlin Chemie, non-financial support from Sanofi Genzyme, personal fees from Novo-Nordisc, personal fees from Mylan, personal fees from CSL Behring, personal fees from Belupo, personal fees from Amgen, personal fees from Alkaloid, outside the submitted work. Dr. Flammer reports personal fees from Alnylam, grants and personal fees from AstraZeneca, personal fees from Bayer, personal fees from Boehringer Ingelheim, personal fees from Fresenius, personal fees from Imedos GmBH, personal fees from Medtronic, personal fees from MSD, personal fees from Mundipharma, grants and personal fees from Novartis, personal fees from Pierre Fabre, personal fees from Pfizer, personal fees from Roche, personal fees from Vifor, personal fees from Zoll, grants from Berlin Heart, outside the submitted work. Dr. Petricevic has nothing to disclose. Dr. Biocina has nothing to disclose. Dr. Lund reports personal fees from Merck, grants and personal fees from Vifor-Fresenius, grants and personal fees from AstraZeneca, grants and personal fees from Relypsa, personal fees from Bayer, grants from Boston Scientific, personal fees from Pharmacosmos, personal fees from Abbott, personal fees from Medscape, personal fees from Myokardia, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis, personal fees from Sanofi, personal fees from Lexicon, outside the submitted work. Dr. Milicic reports personal fees from Boehringer Ingelheim, personal fees from Bayer, personal fees from Pfizer, personal fees from Novartis, personal fees from AstraZeneca, personal fees from Novo Nordisk, personal fees from Teva, personal fees from Servier, outside the submitted work. Dr. Ruschitzka has not received personal payments by pharmaceutical companies or device manufacturers in the last three years (remuneration for the time spent in activities, such as participation in steering committee member of clinical trials, were made directly to the University of Zurich). The Department of Cardiology (University Hospital of Zurich/University of Zurich) reports research-, educational- and/or travel grants from Abbott, Amgen, Astra Zeneca, Bayer, B. Braun, Biosense Webster, Biosensors Europe AG, Biotronik, BMS, Boehringer Ingelheim, Boston Scientific, Bracco, Cardinal Health Switzerland, Daiichi, Diatools AG, Edwards Lifesciences, Guidant Europe NV (BS), Hamilton Health Sciences, Kaneka Corporation, Labormedizinisches Zentrum, Medtronic, MSD, Mundipharma Medical Company, Novartis, Novo Nordisk, Orion, Pfizer, Quintiles Switzerland Sarl, Sanofi, Sarstedt AG, Servier, SIS Medical, SSS International Clinical Research, Terumo Deutschland, V- Wave, Vascular Medical, Vifor, Wissens Plus, ZOLL. The research and educational grants do not impact on Prof. Ruschitzka`s personal remuneration. Dr. Cikes reports grants and personal fees from Novartis, grants and non-financial support from Abbott, personal fees and non-financial support from GE Healthcare, non-financial support from Corvia, personal fees and non-financial support from Pfizer, personal fees from Bayer, personal fees from Boehringer-Ingelheim, personal fees from AstraZeneca, personal fees from Sanofi, personal fees and non-financial support from Teva Pharmaceutical Industries, personal fees from Orion Pharma, personal fees from Medtronic, outside the submitted work.

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Gasparovic, H., Jakus, N., Brugts, J.J. et al. Impact of progressive aortic regurgitation on outcomes after left ventricular assist device implantation. Heart Vessels 37, 1985–1994 (2022). https://doi.org/10.1007/s00380-022-02111-1

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  • DOI: https://doi.org/10.1007/s00380-022-02111-1

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