Journal of Artificial Organs

, Volume 21, Issue 2, pp 150–155 | Cite as

Outflow graft anastomosis site design could be correlated to aortic valve regurgitation under left ventricular assist device support

  • Kei Iizuka
  • Tomohiro Nishinaka
  • Yuki Ichihara
  • Takuma Miyamoto
  • Kenji Yamazaki
Original Article Artificial Heart (Clinical)


Aortic valve regurgitation (AR) is a critical complication during circulatory support with a left ventricular assist device (LVAD). The time-course of AR and related factors, including outflow graft anastomosis site design, were investigated. Twenty-three patients who had continuous-flow LVAD implantation and were supported for more than 6 months were investigated. AR grade (none, 0; trivial, 0.5; mild, 1; mild-moderate, 1.5; moderate, 2; moderate-severe, 2.5; severe, 3) and aortic valve opening were evaluated with echocardiography. Computed tomography was performed to all the patients postoperatively. The angle of the outflow graft to the aorta (O-A angle, parallel 0; tangent 90°, 0–180°), aortic diameter at the anastomosis site, sino-tubular junction (STJ) diameter, distance between the STJ and the anastomosis site, and distance between the anastomosis site and the brachiocephalic artery were measured. The patients’ age was 38 ± 11 years. Support duration was 686 ± 354 days. Mean AR grade after continuous-flow LVAD implantation was increased to around mild and was maintained thereafter. No patient needed any intervention to the aortic valve. The aortic valves of 82.6% of patients were closed continuously. The O-A angle (83 ± 14) was positively correlated with maximum AR grade (p = 0.0095). The O-A angle was significantly smaller in patients with maximum AR grade of 1 or less (77 ± 9°) than in those with 1.5 or greater (94 ± 15°, p = 0.021). The other CT measurements had no correlation with AR grade. In conclusion, the O-A angle was correlated with AR grade progression. The O-A angle appears to be one of the important factors related to AR under continuous-flow LVAD support.


Aortic valve regurgitation Left ventricular assist device Heart failure Continuous-flow 


Compliance with ethical standards

Conflict of interest

Kenji Yamazaki is a remunerated consultant of SunMedical Technology Research Co. All other authors declare no conflict of interest.


  1. 1.
    Cowger J, Pagani FD, Haft JW, Romano M, Aaronson KD, Kolias TJ. The development of aortic insufficiency in left ventricular assist device-supported patients. Circ Heart Fail. 2010;3:668–74.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Pak SW, Uriel N, Takayama H, Cappleman S, Song R, Colombo PC, et al. Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices. J Heart Lung Transpl. 2010;29:1172–6.CrossRefGoogle Scholar
  3. 3.
    Hatano M, Kinugawa K, Shiga T, Kato N, Endo M, Hisagi M, et al. Less frequent opening of the aortic valve and a continuous flow pump are risk factors for postoperative onset of aortic insufficiency in patients with a left ventricular assist device. Circ J. 2011;75:1147–55.CrossRefPubMedGoogle Scholar
  4. 4.
    Iizuka K, Nishinaka T, Takewa Y, Yamazaki K, Tatsumi E. The influence of pump rotation speed on hemodynamics and myocardial oxygen metabolism in left ventricular assist device support with aortic valve regurgitation. J Artif Organs. 2017;20:194–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Itoda Y, Nawata K, Yamauchi H, Kinoshita O, Kimura M, Ono M. Central aortic valve closure successfully treated aortic insufficiency of the patient with Jarvik 2000 continuous flow left ventricular assist device: a case report. J Artif Organs. 2017;20:99–101.CrossRefPubMedGoogle Scholar
  6. 6.
    Benk C, Mauch A, Beyersdorf F, Klemm R, Russe M, Blanke P, et al. Effect of cannula position in the thoracic aorta with continuous left ventricular support: four-dimensional flow-sensitive magnetic resonance imaging in an in vitro model. Eur J Cardio-thoracic Surg. 2013;44:551–8.CrossRefGoogle Scholar
  7. 7.
    Yamazaki K, Kihara S, Akimoto T, Tagusari O, Kawai A, Umezu M, et al. EVAHEART: an implantable centrifugal blood pump for long-term circulatory support. Jpn J Thorac Cardiovasc Surg. 2002;50:461–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Yamazaki K, Saito S, Kihara S, Tagusari O, Kurosawa H. Completely pulsatile high flow circulatory support with a constant-speed centrifugal blood pump: mechanisms and early clinical observations. Gen Thorac Cardiovasc Surg. 2007;55:158–62.CrossRefPubMedGoogle Scholar
  9. 9.
    Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transpl. 2013;48:452–8.CrossRefGoogle Scholar
  10. 10.
    Patil NP, Sabashnikov A, Mohite PN, Garcia D, Weymann A, Zych B, et al. De novo aortic regurgitation after continuous-flow left ventricular assist device implantation. Ann Thorac Surg. 2014;98:850–7.CrossRefPubMedGoogle Scholar
  11. 11.
    May-Newman K, Hillen B, Dembitsky W. Effect of left ventricular assist device outflow conduit anastomosis location on flow patterns in the native aorta. ASAIO J. 2006;52:132–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Inci G, Sorgüven E. Effect of LVAD outlet graft anastomosis angle on the aortic valve, wall, and flow. ASAIO J. 2012;58:373–81.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society for Artificial Organs 2017

Authors and Affiliations

  • Kei Iizuka
    • 1
  • Tomohiro Nishinaka
    • 1
  • Yuki Ichihara
    • 1
  • Takuma Miyamoto
    • 1
  • Kenji Yamazaki
    • 1
  1. 1.Department of Cardiovascular SurgeryTokyo Women’s Medical UniversityTokyoJapan

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