Aortic Insufficiency and Hemocompatibility-related Adverse Events in Patients with Left Ventricular Assist Devices

Imamura, Teruhiko; Kim, Gene; Nitta, Daisuke; Fujino, Takeo; Smith, Bryan; Kalantari, S.; Nguyen, A.; Narang, Nikhil; Holzhauser, Luise; Grinstein, Jonathan; Juricek, C.; Rodgers, D.; Song, Tae Ho; Ota, Takeyoshi; Jeevanandam, Valluvan; Sayer, Gabriel; Uriel, Nir

doi:10.1016/j.cardfail.2019.08.003

Cited by 15 publications

(19 citation statements)

References 18 publications

(26 reference statements)

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“…Doppler echocardiography of the outflow graft was performed via a modified right parasternal window. The diastolic acceleration slopes were measured and the regurgitant fraction (RF) was calculated using the previously detailed formula: (diastolic acceleration slope + 0.5) × 100/165.4 2,4,7 . Three consecutive RFs were calculated and averaged.…”

Section: Methodsmentioning

confidence: 99%

Impact of worsening of aortic insufficiency during HeartMate 3 LVAD support

et al. 2020

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Aortic insufficiency remains a difficult to treat and highly morbid condition even in the era of HeartMate 3 left ventricular assist devices (LVADs). The prognostic nature of the longitudinal progression of aortic insufficiency, however, remains unknown. We prospectively collected data on patients who received HeartMate 3 LVAD implantation, who had assessments of aortic insufficiency using a novel Doppler echocardiography obtained at outflow graft at three (baseline) and 6 months postimplant. Patients with moderate or greater aortic insufficiency at baseline were excluded. The risk of aortic insufficiency progression on 1‐year death and readmission for heart failure was investigated. In total, 41 patients (median 51 years old and 29 males) were included. All patients had less than moderate aortic insufficiency at baseline. Of them, 22 patients had worsening aortic insufficiency for 3 months following baseline assessments, which was associated with a significantly higher risk of 1‐year death or heart failure readmission rate (41% vs. 11%, P = .023) with a hazard ratio of 3.24 (95% confidence interval 1.02‐18.5, P = .038) adjusted for device speed at baseline and destination therapy indication. In patients with HeartMate 3 LVADs, progressive aortic insufficiency may be associated with a higher risk of 1‐year death or readmission for heart failure. Close monitoring of patients with baseline aortic insufficiency should be considered as a measure to risk‐stratify those for future adverse events.

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Section: Methodsmentioning

confidence: 99%

Impact of worsening of aortic insufficiency during HeartMate 3 LVAD support

et al. 2020

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“…51 The risk of developing significant AI is increased among those with preexisting aortic regurgitation and once extended augments the rate of mortality together with the incidence of hemocompatibility-related adverse events. 52,53 Accepted surgical techniques to rectify AI in patients…”

Section: Aortic Insufficiencymentioning

confidence: 99%

Left Ventricular Assist Device-Related Complications

Clément¹,

Anghel

Sascău

et al. 2020

Journal of Cardiovascular Emergencies

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Left ventricular assist device (LVAD) has emerged as a safe, durable, and revolutionary therapy for end-stage heart failure patients. Despite the appearance of newer-generation devices that have improved patient outcomes, the burden of adverse events remains significant. Although the survival rate for patients with LVAD is appreciated to be 81% at 1 year and 70% at 2 years, the incidence of adverse events is also high. Over time, both early and late postimplant complications have diminished in terms of prevalence and impact; however, complications, such as infections, bleeding, right heart failure, pump thrombosis, aortic insufficiency, or stroke, continue to represent a challenge for the practitioner. Therefore, the aim of this review is to highlight the most recent data regarding the current use of LVAD in the treatment of end-stage heart failure, with a specific focus on LVAD-related complications, in order to improve device-related outcomes. It will also revise how to mitigate the risk and how to approach specific adverse events. Withal, understanding the predisposing risk factors associated with postimplant complications, early recognition and appropriate treatment help to significantly improve the prognosis for patients with end-stage heart failure.

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“…Using these novel methods, many LVAD patients may have significant aortic insufficiency before clinical symptomology develops. Generally, the only definitive therapies are valve replacement or urgent heart transplantation [ 55 ].…”

Section: Hemodynamic Patterns By Disease Processmentioning

confidence: 99%

“… Pulse-Doppler echocardiography obtained at the outflow graft of left ventricular assist device (reused with permission [ 55 ]).The regurgitant fraction is estimated using the slope of diastolic acceleration (yellow bar). ( A ) no aortic insufficiency; ( B ) severe aortic insufficiency.…”

Section: Figurementioning

confidence: 99%

Implication of Hemodynamic Assessment during Durable Left Ventricular Assist Device Support

Imamura

Narang

2020

Medicina

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Durable left ventricular assist device therapy has improved survival in patients with advanced heart failure refractory to conventional medical therapy, although the readmission rates due to device-related comorbidities remain high. Left ventricular assist devices are designed to support a failing left ventricle through relief of congestion and improvement of cardiac output. However, many patients still have abnormal hemodynamics even though they may appear to be clinically stable. Furthermore, such abnormal hemodynamics are associated with an increased risk of future adverse events including recurrent heart failure, gastrointestinal bleeding, stroke, and pump thrombosis. Correction of residual hemodynamic derangements post-implantation may be a target in improving longitudinal clinical outcomes during left ventricular assist device support. Automatic and timely device speed adjustments considering a patients’ hemodynamic status (i.e., with a smart pump) are potential improvements in forthcoming devices.

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Aortic Insufficiency and Hemocompatibility-related Adverse Events in Patients with Left Ventricular Assist Devices

Cited by 15 publications

References 18 publications

Impact of worsening of aortic insufficiency during HeartMate 3 LVAD support

Impact of worsening of aortic insufficiency during HeartMate 3 LVAD support

Left Ventricular Assist Device-Related Complications

Implication of Hemodynamic Assessment during Durable Left Ventricular Assist Device Support

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