Aortic insufficiency in continuous-flow left ventricular assist device support patients is common but does not impact long-term mortality

Holley, Christopher T.; Fitzpatrick, Megan J.; Roy, Samit S.; Alraies, M. Chadi; Cogswell, Rebecca; Souslian, Laura; Eckman, Peter; John, Ranjit

doi:10.1016/j.healun.2016.07.018

Cited by 45 publications

(41 citation statements)

References 16 publications

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“…With regards to renal dysfunction, current data show that LVAD implantation can lead to an improvement (27). On the other hand, LVAD is not a panacea and there are multiple subgroups of patients who have contraindications for LVAD implantation, including those prone to infection, elderly patients and patients with untreated aortic regurgitation (28)(29)(30)(31). Furthermore, LVAD implantation may be associated with increased tendency to ventricular tachyarrhythmia (32).…”

Section: Discussionmentioning

confidence: 99%

Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis

Theochari¹,

Michalopoulos²,

Oikonomou³

et al. 2018

Ann. Cardiothorac. Surg.

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Background: The optimal treatment for advanced heart failure (HF) patients with regards to mortality remains unknown. Heart transplantation (HTx) and left ventricular assist devices (LVAD) used either as a bridge to transplant (BTT) or destination therapy (DT) have been compared in a number of studies, without definite conclusions with regards to mortality benefit. We sought to systematically review the pertinent literature and perform a meta-analysis of all the available studies presenting head-to-head comparisons between HTx and LVAD BTT or LVAD DT for late (>6 months) all-cause mortality.Methods: We performed a systematic search of Medline and Cochrane Central databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a meta-analysis of late mortality comparing HTx vs. BTT LVAD and HTx vs. DT LVAD using a random effects model.Results: Eight studies were included in our meta-analysis, reporting data on 7,957 patients in total.Although the available studies are of high quality [8 stars in Newcastle-Ottawa Scale (NOS) on average], there is paucity of mortality data. Specifically, seven studies compared HTx with BTT and five studies compared HTx with DT for 1-year mortality. Our pooled estimates showed that there was no difference in late mortality among these strategies. Conclusions:Our meta-analysis highlights the small number and the heterogeneity of available studies referring to the optimal invasive management of advanced HF, and shows that there are no differences between HTx and LVAD for these patients with regards to late mortality.

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Section: Discussionmentioning

confidence: 99%

Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis

Theochari¹,

Michalopoulos²,

Oikonomou³

et al. 2018

Ann. Cardiothorac. Surg.

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show abstract

“…AR may be corrected at the time of LVAD implantation either by valve replacement using a bioprosthesis or by oversewing the valve. Results regarding outcome after LVAD implantation requiring aortic valve intervention are conflicting, and some centres consider significant AR a relative contraindication to LVAD implantation or at least a factor which must be weighed in the overall operative risk.…”

Section: Specific Considerations Relating To Left Ventricular Assist mentioning

confidence: 99%

Left ventricular assist device therapy in advanced heart failure: patient selection and outcomes

Gustafsson

Rogers

2017

European J of Heart Fail

233

190

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Despite improvements in pharmacological therapy and pacing, prognosis in advanced heart failure (HF) remains poor, with a 1-year mortality of 25-50%. While heart transplantation provides excellent survival and quality of life for eligible patients, only a few can be offered this treatment due to shortage of donor organs. Implantable left ventricular assist device (LVAD) technology has improved considerably, and the currently used continuous flow devices may last >10 years in a patient. LVADs are being used increasingly both as bridge-to-transplantation and as destination therapy. Current studies report 1- and 2-year survival after LVAD implantation of 80% and 70%, respectively. Outcome after LVAD implantation in stable patients is superior to that of 'crash and burn' patients or patients sliding on inotropes, favouring early referral and implantation. This review summarizes factors to consider when deciding on LVAD implantation such as age, co-morbidity, and cardiac pathophysiology. Complications to LVAD therapy are reviewed. It is concluded that while complications with LVAD therapy are not uncommon, most are manageable, and current outcomes clearly justify use of LVADs in advanced HF.

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“…Aortic regurgitation (AR) is a well-described complication of long-term cfVAD support. 20 , 21 Its onset is often gradual but once of sufficient severity, significant and deleterious clinical consequences may ensue. These are generally manifest as an inability to unload the LV with emergence of symptoms of left and RHF.…”

Section: Clinical Scenariosmentioning

confidence: 99%

HVAD Flow Waveform Morphologies: Theoretical Foundation and Implications for Clinical Practice

Rich

Burkhoff

2017

ASAIO Journal

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Continuous-flow ventricular assist device (cfVAD) performance and patient hemodynamic conditions are intimately interrelated and dynamic, changing frequently with alterations in physiologic conditions, particularly pre- and afterloading conditions. The Heartware cfVAD (HVAD) provides a unique feature among currently approved VADs of providing an estimated instantaneous flow waveform, the characteristics of which can provide significant insights into patient and device properties. Despite being readily available, HVAD waveforms are poorly understood, underutilized, and insufficiently leveraged, even by clinicians who regularly manage HVAD patients. The purpose of this review is to provide the theoretical foundation for understanding the determinants of HVAD waveform characteristics and to provide practical examples illustrating how to interpret and integrate changes of HVAD waveforms into clinical practice. Heartware cfVAD waveforms should be considered a complimentary tool for the optimization of medical therapies and device speed in HVAD patients.

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Aortic insufficiency in continuous-flow left ventricular assist device support patients is common but does not impact long-term mortality

Cited by 45 publications

References 16 publications

Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis

Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis

Left ventricular assist device therapy in advanced heart failure: patient selection and outcomes

HVAD Flow Waveform Morphologies: Theoretical Foundation and Implications for Clinical Practice

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