De Novo Aortic Regurgitation After Continuous-Flow Left Ventricular Assist Device Implantation

Patil, Nikhil P.; Sabashnikov, Anton; Mohite, Prashant N.; Garcia, Diana; Weymann, Alexander; Zych, Bartłomiej; Bowles, Christopher; Hards, Rachel; Hedger, M.; Popov, Aron Frederik; Robertis, Fabio De; Moza, Ajay; Bahrami, Toufan; Amrani, Mohamed; Rahman-Haley, Shelley; Banner, Nicholas R.; Simón, A.

doi:10.1016/j.athoracsur.2014.05.030

Cited by 48 publications

(38 citation statements)

References 14 publications

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“…Clinical studies carried out in the USA, where HM-II has been used as the main device (between 94 and 100% of all studied CF-LVAD patients) with a longer observation period, reported that 52-64% of HM-II patients had developed significant AI. 1,2,6,7 Alternatively, a UK study reported the incidence of mild or greater AI to be 43.1% in HM-II vs. 65.7% in HVAD recipients, 3 the opposite of the present findings. In contrast, Soleimani et al reported that 0/8 patients (0%) developed AI at a mean of 158 days with the HVAD vs. 6/55 (10.9%) with the HM-II at a mean of 314 days.…”

Section: Influence Of Device Type On De Novo Aicontrasting

confidence: 55%

Aortic Valve Pathology in Patients Supported by Continuous-Flow Left Ventricular Assist Device

Saito

Wassilew

Gorodetski

et al. 2016

Circ J

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Section: Influence Of Device Type On De Novo Aicontrasting

confidence: 55%

Aortic Valve Pathology in Patients Supported by Continuous-Flow Left Ventricular Assist Device

Saito

Wassilew

Gorodetski

et al. 2016

Circ J

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“…Prior studies have found that 33-52% of LVAD patients develop AI, with two studies noting no difference in survival in the groups with and without significant post-LVAD AI (18)(19)(20). We noted a significant increase in AI at follow-up, which has been noted in several previous studies.…”

Section: Discussionsupporting

confidence: 83%

“…We noted a significant increase in AI at follow-up, which has been noted in several previous studies. Prior studies have found that 33-52% of LVAD patients develop AI, with two studies noting no difference in survival in the groups with and without significant post-LVAD AI (18)(19)(20). In a study by Rajagopal et al, significant development of moderate or worse AI was observed, but those with moderate AI had adequate unloading of the left ventricle (21).…”

Section: Discussionmentioning

confidence: 99%

Cardiac Index Declines During Long‐Term Left Ventricular Device Support

Kalathiya¹,

Houston²,

Chaisson³

et al. 2016

Artificial Organs

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To investigate longitudinal trends in valvular and ventricular function with long-term left ventricular assist device (LVAD) therapy, we analyzed hemodynamic and echocardiographic data of patients with at least 2 years of continuous LVAD support. All 130 patients who underwent HeartMate II implantation at our institution between 2005 and 2012 were reviewed. Twenty patients had hemodynamic and echocardiographic evaluations in both the early (0-6 months) and late (2-3 years) postoperative period. Patients on inotropic therapy or temporary mechanical support were excluded. The average times of early and late hemodynamic evaluations were 59 ± 41 days and 889 ± 160 days, respectively. Cardiac index (CI) declined by an average of 0.4 L/min/m (P = 0.04) with concomitant increase in pulmonary capillary wedge pressure (PCWP; P = 0.02). The right atrial pressure to PCWP (RAP:PCWP) ratio decreased during LVAD support suggesting improvement in right ventricular function. While there was an increase in degree of aortic insufficiency (AI) at the late follow-up period (P = 0.008), dichotomization by median decline in CI (-0.4 L/min/m ) indicated no difference in prevalence of AI among the groups. CI declined in patients with HeartMate II after 2 years of continuous support. An increase in preload and afterload was observed in those with the greatest decline in CI.

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“…Multiple studies have demonstrated the risk of developing AV pathology, aortic regurgitation and leaflet fusion [20, 21]. This has been shown in patients with the HeartWare HVAD (centrifugal pump), the Thoratec HMI and the HMII (axial flow pump) [22, 23]. The risk of development of AV disease is reduced in patients managed to allow intermittent AV opening [24, 25].…”

Section: Introductionmentioning

confidence: 99%

Impact of LVAD Implantation Site on Ventricular Blood Stagnation

Prisco¹,

Aliseda

Beckman

et al. 2017

ASAIO Journal

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Treatment of end-stage heart failure includes cardiac transplantation or ventricular assist device (VAD) therapy. While increasingly prevalent, current VAD therapy has inherent complications, including thrombosis. Studies have demonstrated that VAD implantation alters intra-cardiac blood flow, creating areas of stagnation that predispose to thrombus formation. Two potential surgical configurations exist for VAD implantation: through the apical or diaphragmatic surfaces of the heart. We hypothesized that diaphragmatic implantation causes more stagnation than apical implantation. We also hypothesized that intermittent aortic valve (AV) opening reduces stagnation of blood inside the left ventricle (LV) when compared to a closed AV. To test these hypotheses, a human left-ventricle geometry was re-created in silico and a VAD inflow cannula was virtually implanted in each configuration. A computational indicator-dilution study was conducted where “virtually-dyed blood” was washed out of the LV by injecting blood with no dye. Simulations demonstrated a substantial reduction in stagnation with intermittent AV opening. In addition, virtual dye was cleared slightly faster in the apical configuration. Simulations from our study demonstrate the clinical importance of VAD management to allow intermittent opening of the AV to prevent subvalvular stagnation, and it also suggests that apical configuration might be more hemodynamically favorable.

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De Novo Aortic Regurgitation After Continuous-Flow Left Ventricular Assist Device Implantation

Cited by 48 publications

References 14 publications

Aortic Valve Pathology in Patients Supported by Continuous-Flow Left Ventricular Assist Device

Aortic Valve Pathology in Patients Supported by Continuous-Flow Left Ventricular Assist Device

Cardiac Index Declines During Long‐Term Left Ventricular Device Support

Impact of LVAD Implantation Site on Ventricular Blood Stagnation

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