Abstract
Since 2011, implantable ventricular assist devices have been a standard treatment for severe heart failure alongside heart transplantation in Japan. However, the limited availability of donors has led to a prolonged wait for transplants, now averaging 1719 days, intensifying the issue of aortic insufficiency in patients with continuous flow ventricular assist devices. These devices limit the opening of the aortic valve, leading to sustained closure and increased shear stress, which accelerates valve degradation. Risk factors for aortic insufficiency include having a smaller body surface area, being of advanced age, and the presence of mild aortic insufficiency prior to device implantation. In patients presenting with mild or moderate aortic regurgitation at the time of ventricular assist device implantation, interventions such as aortic valve repair or bioprosthetic valve replacement are performed with the aim of halting its progression. The choice of surgical procedure should be tailored to each patient’s individual condition. The management of de novo aortic insufficiency in patients with continuous flow ventricular assist devices remains challenging, with no clear consensus on when to intervene. Interventions for significant aortic insufficiency typically consider the patient’s symptoms and aortic insufficiency severity. De novo aortic insufficiency progression in continuous flow ventricular assist devices patients necessitates careful monitoring and intervention based on individual patient assessments and valve condition. This review was created based on a translation of the Japanese review written in the Japanese Journal of Artificial Organs in 2023 (Vol. 52, No. 1, pp. 77–80), with some modifications.
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References
Truby LK, Garan AR, Givens RC, Wayda B, Takeda K, Yuzefpolskaya M, Colombo PC, Naka Y, Takayama H, Topkara VK. Aortic insufficiency during contemporary left ventricular assist device support: analysis of the INTERMACS registry. JACC Heart Fail. 2018;6:951–60.
Cowger J, Pagani FD, Haft JW, Romano MA, Aaronson KD, Kolias TJ. The development of aortic insufficiency in left ventricular assist device-supported patients. Circ Heart Fail. 2010;3:668–74.
Cowger J, Rao V, Massey T, Sun B, May-Newman K, Jorde U, Estep JD. Comprehensive review and suggested strategies for the detection and management of aortic insufficiency in patients with a continuous-flow left ventricular assist device. J Heart Lung Transplant. 2015;34:149–57.
Hatano M, Kinugawa K, Shiga T, Kato N, Endo M, Hisagi M, Nishimura T, Yao A, Hirata Y, Kyo S, Ono M, Nagai R. 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.
Pak SW, Uriel N, Takayama H, Cappleman S, Song R, Colombo PC, Charles S, Mancini D, Gillam L, Naka Y, Jorde UP. Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices. J Heart Lung Transplant. 2010;29:1172–6.
Rajagopal K, Daneshmand MA, Patel CB, Ganapathi AM, Schechter MA, Rogers JG, Milano CA. Natural history and clinical effect of aortic valve regurgitation after left ventricular assist device implantation. J Thorac Cardiovasc Surg. 2013;145:1373–9.
Ambardekar AV, Hunter KS, Babu AN, Tuder RM, Dodson RB, Lindenfeld J. Changes in aortic wall structure, composition, and stiffness with continuous-flow left ventricular assist devices: a pilot study. Circ Heart Fail. 2015;8:944–52.
Rose AG, Park SJ, Bank AJ, Miller LW. Partial aortic valve fusion induced by left ventricular assist device. Ann Thorac Surg. 2000;70:1270–4.
Mudd JO, Cuda JD, Halushka M, Soderlund KA, Conte JV, Russell SD. Fusion of aortic valve commissures in patients supported by a continuous axial flow left ventricular assist device. J Heart Lung Transplant. 2008;27:1269–74.
da Rocha ESJG, Meyer AL, Eifert S, Garbade J, Mohr FW, Strueber M. Influence of aortic valve opening in patients with aortic insufficiency after left ventricular assist device implantation. Eur J Cardiothorac Surg. 2016;49:784–7.
Kasinpila P, Kong S, Fong R, Shad R, Kaiser AD, Marsden AL, Woo YJ, Hiesinger W. Use of patient-specific computational models for optimization of aortic insufficiency after implantation of left ventricular assist device. J Thorac Cardiovasc Surg. 2021;162:1556–63.
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.
Callington A, Long Q, Mohite P, Simon A, Mittal TK. Computational fluid dynamic study of hemodynamic effects on aortic root blood flow of systematically varied left ventricular assist device graft anastomosis design. J Thorac Cardiovasc Surg. 2015;150:696–704.
Westaby S, Bertoni GB, Clelland C, Nishinaka T, Frazier OH. Circulatory support with attenuated pulse pressure alters human aortic wall morphology. J Thorac Cardiovasc Surg. 2007;133:575–6.
Tuzun E, Rutten M, Dat M, van de Vosse F, Kadipasaoglu C, de Mol B. Continuous-flow cardiac assistance: effects on aortic valve function in a mock loop. J Surg Res. 2011;171:443–7.
Rao SD, Johnson B, Olia SE, Wald J, Medina V, Rame JE, Mazurek JA, Goldberg LR, Atluri P, Bermudez C, Acker M, Birati EY. Treatment with impella increases the risk of de novo aortic insufficiency post left ventricular assist device implant. J Card Fail. 2020;26:870–5.
Hironaka CE, Ortoleva J, Zhan Y, Chen FY, Couper GS, Kapur NK, Kawabori M. The effects of percutaneous left ventricular assist device placement on native valve competency. ASAIO J. 2022;68:541–6.
Holley CT, Fitzpatrick M, Roy SS, Alraies MC, Cogswell R, Souslian L, Eckman P, John R. Aortic insufficiency in continuous-flow left ventricular assist device support patients is common but does not impact long-term mortality. J Heart Lung Transplant. 2017;36:91–6.
Patil NP, Mohite PN, Sabashnikov A, Dhar D, Weymann A, Zeriouh M, Koch A, Garcia-Saez D, Zych B, Hards R, Hedger M, De Robertis F, Moza A, Bahrami T, Amrani M, Rahman-Haley S, Popov AF, Banner N, Simon AR. Does postoperative blood pressure influence development of aortic regurgitation following continuous-flow left ventricular assist device implantation? Eur J Cardiothorac Surg. 2016;49:788–94.
Toda K, Fujita T, Domae K, Shimahara Y, Kobayashi J, Nakatani T. Late aortic insufficiency related to poor prognosis during left ventricular assist device support. Ann Thorac Surg. 2011;92:929–34.
Kirklin JK, Pagani FD, Goldstein DJ, John R, Rogers JG, Atluri P, Arabia FA, Cheung A, Holman W, Hoopes C, Jeevanandam V, John R, Jorde UP, Milano CA, Moazami N, Naka Y, Netuka I, Pagani FD, Pamboukian SV, Pinney S, Rogers JG, Selzman CH, Silverstry S, Slaughter M, Stulak J, Teuteberg J, Vierecke J, Schueler S, D’Alessandro DA. American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support. J Heart Lung Transplant. 2020;39:187–219.
McKellar SH, Deo S, Daly RC, Durham LA 3rd, Joyce LD, Stulak JM, Park SJ. Durability of central aortic valve closure in patients with continuous flow left ventricular assist devices. J Thorac Cardiovasc Surg. 2014;147:344–8.
Adamson RM, Dembitsky WP, Baradarian S, Chammas J, May-Newman K, Chillcott S, Stahovich M, McCalmont V, Ortiz K, Hoagland P, Jaski B. Aortic valve closure associated with HeartMate left ventricular device support: technical considerations and long-term results. J Heart Lung Transplant. 2011;30:576–82.
Veenis JF, Yalcin YC, Brugts JJ, Constantinescu AA, Manintveld OC, Bekkers JA, Bogers A, Caliskan K. Survival following a concomitant aortic valve procedure during left ventricular assist device surgery: an ISHLT Mechanically Assisted Circulatory Support (IMACS) Registry analysis. Eur J Heart Fail. 2020;22:1878–87.
Yalcin YC, Veenis JF, Brugts JJ, Antonides CFJ, Veen KM, Muslem R, Bekkers JA, Gustafsson F, Tedford RJ, Bogers A, Caliskan K. Rate of thromboembolic and bleeding events in patients undergoing concomitant aortic valve surgery with left ventricular assist device implantation. Int J Cardiol. 2022;359:39–45.
Robertson JO, Naftel DC, Myers SL, Prasad S, Mertz GD, Itoh A, Pagani FD, Kirklin JK, Silvestry SC. Concomitant aortic valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: an INTERMACS database analysis. J Heart Lung Transplant. 2015;34:797–805.
Dhillon AS, Jones BM, Hodson RW, Korngold EC. Transcatheter aortic valve replacement for severe aortic regurgitation in patients with a left ventricular assist device. J Invasive Cardiol. 2022;34:E369–73.
Yehya A, Rajagopal V, Meduri C, Kauten J, Brown M, Dean L, Webster J, Krishnamoorthy A, Hrobowski T, Dean D. Short-term results with transcatheter aortic valve replacement for treatment of left ventricular assist device patients with symptomatic aortic insufficiency. J Heart Lung Transplant. 2019;38:920–6.
Retzer EM, Sayer GT, Fedson SE, Nathan S, Jeevanandam V, Friant J, Uriel N, Lang RM, Russo MJ, Shah AP. Predictors of survival following trans-catheter aortic valve closure for left ventricular assist device associated aortic insufficiency. Catheter Cardiovasc Interv. 2016;87:971–9.
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We thank Jane Charbonneau, DVM, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.
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Tadokoro, N., Tonai, K., Kainuma, S. et al. Management of aortic valve insufficiency in patients with continuous-flow left ventricular assist device: a republication of the review published in Japanese Journal of Artificial Organs. J Artif Organs (2024). https://doi.org/10.1007/s10047-024-01439-x
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DOI: https://doi.org/10.1007/s10047-024-01439-x