Aortic valve procedures at the time of ventricular assist device placement

Ayumi Goda, Hiroo Takayama, Sang Woo Pak, Nir Uriel, Donna Mancini, Yoshifumi Naka, Ulrich P. Jorde

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Placement of a ventricular assist device (VAD) may lead to reduced or absent opening of the aortic valve and thus increase risk of thrombus formation in the aortic root as well as on the valve itself. The outcome of additional procedures to the aortic valve at the time of VAD placement is unclear. Methods A retrospective analysis of 712 VAD patients from 1995 to 2009 was performed. Results Twenty-eight patients were identified who underwent aortic valve procedures in addition to VAD placement. Indication for VAD placement was bridge to transplant in 23 patients, destination therapy in 4, and postcardiotomy shock in 1. Aortic valve procedures were performed for preexisting mechanical aortic prosthesis in 8 (7 closure and 1 aortic valve replacement with biological prosthesis), and for moderate or severe aortic insufficiency in 20 patients (10 repair, 9 closure, and 1 aortic valve replacement with biological prosthesis). At the last follow-up, 16 patients had undergone heart transplant, 6 remained on VAD support, and 5 had died. While on VAD support, no adverse events related to the aortic valve procedures occurred. The 30-day operative mortality was 0.4%. No clinical thromboembolic events were observed. In 2 patients, there was evidence of thrombus formation in the explanted heart. Four patients had bleeding complications. Of the 9 patients who received aortic valve repair, 2 had recurrent aortic insufficiency on echocardiograms during an average follow-up of 118 days. Conclusions Additional procedures to the aortic valve at the time of VAD placement are feasible. Overall outcomes are comparable to those seen in patients without the need for aortic valve manipulation at the time of VAD placement.

Original languageEnglish (US)
Pages (from-to)750-754
Number of pages5
JournalAnnals of Thoracic Surgery
Volume91
Issue number3
DOIs
StatePublished - Mar 2011
Externally publishedYes

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Heart-Assist Devices
Aortic Valve
Prostheses and Implants
Thrombosis
Transplants
Shock
Hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Aortic valve procedures at the time of ventricular assist device placement. / Goda, Ayumi; Takayama, Hiroo; Pak, Sang Woo; Uriel, Nir; Mancini, Donna; Naka, Yoshifumi; Jorde, Ulrich P.

In: Annals of Thoracic Surgery, Vol. 91, No. 3, 03.2011, p. 750-754.

Research output: Contribution to journalArticle

Goda, Ayumi ; Takayama, Hiroo ; Pak, Sang Woo ; Uriel, Nir ; Mancini, Donna ; Naka, Yoshifumi ; Jorde, Ulrich P. / Aortic valve procedures at the time of ventricular assist device placement. In: Annals of Thoracic Surgery. 2011 ; Vol. 91, No. 3. pp. 750-754.
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abstract = "Background: Placement of a ventricular assist device (VAD) may lead to reduced or absent opening of the aortic valve and thus increase risk of thrombus formation in the aortic root as well as on the valve itself. The outcome of additional procedures to the aortic valve at the time of VAD placement is unclear. Methods A retrospective analysis of 712 VAD patients from 1995 to 2009 was performed. Results Twenty-eight patients were identified who underwent aortic valve procedures in addition to VAD placement. Indication for VAD placement was bridge to transplant in 23 patients, destination therapy in 4, and postcardiotomy shock in 1. Aortic valve procedures were performed for preexisting mechanical aortic prosthesis in 8 (7 closure and 1 aortic valve replacement with biological prosthesis), and for moderate or severe aortic insufficiency in 20 patients (10 repair, 9 closure, and 1 aortic valve replacement with biological prosthesis). At the last follow-up, 16 patients had undergone heart transplant, 6 remained on VAD support, and 5 had died. While on VAD support, no adverse events related to the aortic valve procedures occurred. The 30-day operative mortality was 0.4{\%}. No clinical thromboembolic events were observed. In 2 patients, there was evidence of thrombus formation in the explanted heart. Four patients had bleeding complications. Of the 9 patients who received aortic valve repair, 2 had recurrent aortic insufficiency on echocardiograms during an average follow-up of 118 days. Conclusions Additional procedures to the aortic valve at the time of VAD placement are feasible. Overall outcomes are comparable to those seen in patients without the need for aortic valve manipulation at the time of VAD placement.",
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N2 - Background: Placement of a ventricular assist device (VAD) may lead to reduced or absent opening of the aortic valve and thus increase risk of thrombus formation in the aortic root as well as on the valve itself. The outcome of additional procedures to the aortic valve at the time of VAD placement is unclear. Methods A retrospective analysis of 712 VAD patients from 1995 to 2009 was performed. Results Twenty-eight patients were identified who underwent aortic valve procedures in addition to VAD placement. Indication for VAD placement was bridge to transplant in 23 patients, destination therapy in 4, and postcardiotomy shock in 1. Aortic valve procedures were performed for preexisting mechanical aortic prosthesis in 8 (7 closure and 1 aortic valve replacement with biological prosthesis), and for moderate or severe aortic insufficiency in 20 patients (10 repair, 9 closure, and 1 aortic valve replacement with biological prosthesis). At the last follow-up, 16 patients had undergone heart transplant, 6 remained on VAD support, and 5 had died. While on VAD support, no adverse events related to the aortic valve procedures occurred. The 30-day operative mortality was 0.4%. No clinical thromboembolic events were observed. In 2 patients, there was evidence of thrombus formation in the explanted heart. Four patients had bleeding complications. Of the 9 patients who received aortic valve repair, 2 had recurrent aortic insufficiency on echocardiograms during an average follow-up of 118 days. Conclusions Additional procedures to the aortic valve at the time of VAD placement are feasible. Overall outcomes are comparable to those seen in patients without the need for aortic valve manipulation at the time of VAD placement.

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