Prevalence, significance, and management of aortic insufficiency in continuous flow left ventricular assist device recipients

Ulrich P. Jorde, Nir Uriel, Nadav Nahumi, David Bejar, Jose Gonzalez-Costello, Sunu S. Thomas, Jason Han, Kerry A. Morrison, Sophie Jones, Susheel Kodali, Rebecca T. Hahn, Sofia Shames, Melana Yuzefpolskaya, Paolo Colombo, Hiroo Takayama, Yoshifumi Naka

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

Background-Aortic insufficiency (AI) is increasingly recognized as a complication of continuous flow left ventricular assist device support; however, its long-term prevalence, clinical significance, and efficacy of potential interventions are not well known. Methods and Results-We studied the prevalence and management of AI in 232 patients with continuous flow left ventricular assist device at our institution. Patients with aortic valve (AV) surgery before left ventricular assist device implantation were excluded from analysis. To examine the prevalence of de novo AI, patients without preoperative AI were divided into a retrospective and a prospective cohort based on whether a dedicated speed optimization study had been performed at the time of discharge. Forty-three patients underwent AV repair at the time of implant, and 3 subsequently developed greater than mild AI. In patients without surgical AV manipulation and no AI at the time of implant, Kaplan-Meier analysis revealed that freedom from greater than mild de novo AI at 1 year was 77.6±4.2%, and that at least moderate AI is expected to develop in 37.6±13.3% after 3 years. Nonopening of the AV was strongly associated with de novo AI development in patients without prospective discharge speed optimization. Seven of 21 patients with at least moderate AI developed symptomatic heart failure requiring surgical intervention. Conclusions-AI is common in patients with continuous flow left ventricular assist devices and may lead to clinical decompensation requiring surgical correction. The prevalence of AI is substantially less in patients whose AV opens, and optimized loading conditions may reduce AI prevalence in those patients in whom AV opening cannot be achieved.

Original languageEnglish (US)
Pages (from-to)310-319
Number of pages10
JournalCirculation: Heart Failure
Volume7
Issue number2
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Heart-Assist Devices
Aortic Valve
Kaplan-Meier Estimate
Surgical Instruments
Heart Failure

Keywords

  • Aortic valve insufficiency
  • Echocardiography
  • Heart-assist devices

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Prevalence, significance, and management of aortic insufficiency in continuous flow left ventricular assist device recipients. / Jorde, Ulrich P.; Uriel, Nir; Nahumi, Nadav; Bejar, David; Gonzalez-Costello, Jose; Thomas, Sunu S.; Han, Jason; Morrison, Kerry A.; Jones, Sophie; Kodali, Susheel; Hahn, Rebecca T.; Shames, Sofia; Yuzefpolskaya, Melana; Colombo, Paolo; Takayama, Hiroo; Naka, Yoshifumi.

In: Circulation: Heart Failure, Vol. 7, No. 2, 2014, p. 310-319.

Research output: Contribution to journalArticle

Jorde, UP, Uriel, N, Nahumi, N, Bejar, D, Gonzalez-Costello, J, Thomas, SS, Han, J, Morrison, KA, Jones, S, Kodali, S, Hahn, RT, Shames, S, Yuzefpolskaya, M, Colombo, P, Takayama, H & Naka, Y 2014, 'Prevalence, significance, and management of aortic insufficiency in continuous flow left ventricular assist device recipients', Circulation: Heart Failure, vol. 7, no. 2, pp. 310-319. https://doi.org/10.1161/CIRCHEARTFAILURE.113.000878
Jorde, Ulrich P. ; Uriel, Nir ; Nahumi, Nadav ; Bejar, David ; Gonzalez-Costello, Jose ; Thomas, Sunu S. ; Han, Jason ; Morrison, Kerry A. ; Jones, Sophie ; Kodali, Susheel ; Hahn, Rebecca T. ; Shames, Sofia ; Yuzefpolskaya, Melana ; Colombo, Paolo ; Takayama, Hiroo ; Naka, Yoshifumi. / Prevalence, significance, and management of aortic insufficiency in continuous flow left ventricular assist device recipients. In: Circulation: Heart Failure. 2014 ; Vol. 7, No. 2. pp. 310-319.
@article{c0e7ad6383cb460db8b87508c6464f95,
title = "Prevalence, significance, and management of aortic insufficiency in continuous flow left ventricular assist device recipients",
abstract = "Background-Aortic insufficiency (AI) is increasingly recognized as a complication of continuous flow left ventricular assist device support; however, its long-term prevalence, clinical significance, and efficacy of potential interventions are not well known. Methods and Results-We studied the prevalence and management of AI in 232 patients with continuous flow left ventricular assist device at our institution. Patients with aortic valve (AV) surgery before left ventricular assist device implantation were excluded from analysis. To examine the prevalence of de novo AI, patients without preoperative AI were divided into a retrospective and a prospective cohort based on whether a dedicated speed optimization study had been performed at the time of discharge. Forty-three patients underwent AV repair at the time of implant, and 3 subsequently developed greater than mild AI. In patients without surgical AV manipulation and no AI at the time of implant, Kaplan-Meier analysis revealed that freedom from greater than mild de novo AI at 1 year was 77.6±4.2{\%}, and that at least moderate AI is expected to develop in 37.6±13.3{\%} after 3 years. Nonopening of the AV was strongly associated with de novo AI development in patients without prospective discharge speed optimization. Seven of 21 patients with at least moderate AI developed symptomatic heart failure requiring surgical intervention. Conclusions-AI is common in patients with continuous flow left ventricular assist devices and may lead to clinical decompensation requiring surgical correction. The prevalence of AI is substantially less in patients whose AV opens, and optimized loading conditions may reduce AI prevalence in those patients in whom AV opening cannot be achieved.",
keywords = "Aortic valve insufficiency, Echocardiography, Heart-assist devices",
author = "Jorde, {Ulrich P.} and Nir Uriel and Nadav Nahumi and David Bejar and Jose Gonzalez-Costello and Thomas, {Sunu S.} and Jason Han and Morrison, {Kerry A.} and Sophie Jones and Susheel Kodali and Hahn, {Rebecca T.} and Sofia Shames and Melana Yuzefpolskaya and Paolo Colombo and Hiroo Takayama and Yoshifumi Naka",
year = "2014",
doi = "10.1161/CIRCHEARTFAILURE.113.000878",
language = "English (US)",
volume = "7",
pages = "310--319",
journal = "Circulation: Heart Failure",
issn = "1941-3297",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Prevalence, significance, and management of aortic insufficiency in continuous flow left ventricular assist device recipients

AU - Jorde, Ulrich P.

AU - Uriel, Nir

AU - Nahumi, Nadav

AU - Bejar, David

AU - Gonzalez-Costello, Jose

AU - Thomas, Sunu S.

AU - Han, Jason

AU - Morrison, Kerry A.

AU - Jones, Sophie

AU - Kodali, Susheel

AU - Hahn, Rebecca T.

AU - Shames, Sofia

AU - Yuzefpolskaya, Melana

AU - Colombo, Paolo

AU - Takayama, Hiroo

AU - Naka, Yoshifumi

PY - 2014

Y1 - 2014

N2 - Background-Aortic insufficiency (AI) is increasingly recognized as a complication of continuous flow left ventricular assist device support; however, its long-term prevalence, clinical significance, and efficacy of potential interventions are not well known. Methods and Results-We studied the prevalence and management of AI in 232 patients with continuous flow left ventricular assist device at our institution. Patients with aortic valve (AV) surgery before left ventricular assist device implantation were excluded from analysis. To examine the prevalence of de novo AI, patients without preoperative AI were divided into a retrospective and a prospective cohort based on whether a dedicated speed optimization study had been performed at the time of discharge. Forty-three patients underwent AV repair at the time of implant, and 3 subsequently developed greater than mild AI. In patients without surgical AV manipulation and no AI at the time of implant, Kaplan-Meier analysis revealed that freedom from greater than mild de novo AI at 1 year was 77.6±4.2%, and that at least moderate AI is expected to develop in 37.6±13.3% after 3 years. Nonopening of the AV was strongly associated with de novo AI development in patients without prospective discharge speed optimization. Seven of 21 patients with at least moderate AI developed symptomatic heart failure requiring surgical intervention. Conclusions-AI is common in patients with continuous flow left ventricular assist devices and may lead to clinical decompensation requiring surgical correction. The prevalence of AI is substantially less in patients whose AV opens, and optimized loading conditions may reduce AI prevalence in those patients in whom AV opening cannot be achieved.

AB - Background-Aortic insufficiency (AI) is increasingly recognized as a complication of continuous flow left ventricular assist device support; however, its long-term prevalence, clinical significance, and efficacy of potential interventions are not well known. Methods and Results-We studied the prevalence and management of AI in 232 patients with continuous flow left ventricular assist device at our institution. Patients with aortic valve (AV) surgery before left ventricular assist device implantation were excluded from analysis. To examine the prevalence of de novo AI, patients without preoperative AI were divided into a retrospective and a prospective cohort based on whether a dedicated speed optimization study had been performed at the time of discharge. Forty-three patients underwent AV repair at the time of implant, and 3 subsequently developed greater than mild AI. In patients without surgical AV manipulation and no AI at the time of implant, Kaplan-Meier analysis revealed that freedom from greater than mild de novo AI at 1 year was 77.6±4.2%, and that at least moderate AI is expected to develop in 37.6±13.3% after 3 years. Nonopening of the AV was strongly associated with de novo AI development in patients without prospective discharge speed optimization. Seven of 21 patients with at least moderate AI developed symptomatic heart failure requiring surgical intervention. Conclusions-AI is common in patients with continuous flow left ventricular assist devices and may lead to clinical decompensation requiring surgical correction. The prevalence of AI is substantially less in patients whose AV opens, and optimized loading conditions may reduce AI prevalence in those patients in whom AV opening cannot be achieved.

KW - Aortic valve insufficiency

KW - Echocardiography

KW - Heart-assist devices

UR - http://www.scopus.com/inward/record.url?scp=84900004511&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84900004511&partnerID=8YFLogxK

U2 - 10.1161/CIRCHEARTFAILURE.113.000878

DO - 10.1161/CIRCHEARTFAILURE.113.000878

M3 - Article

C2 - 24415682

AN - SCOPUS:84900004511

VL - 7

SP - 310

EP - 319

JO - Circulation: Heart Failure

JF - Circulation: Heart Failure

SN - 1941-3297

IS - 2

ER -