Does postoperative blood pressure influence development of aortic regurgitation following continuous-flow left ventricular assist device implantation?

Abstract

BP readings at 3 months and 6 months showed a statistically significant association with ≥mild AR following CF-LVAD implantation, with systolic blood pressure at 3 months, aortic valve closure and longer support duration being independent predictors. Clinical implications of these data may warrant consideration of aggressive early control of BP to protect against the development/progress of AR following CF-LVAD implantation.

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

“…In three of the eight studies, significant AR was defined as being more than mild [4,6,11]. In five of the included studies, patients were considered to have significant AR if it was mild or greater [7,10,[12][13][14]. The incidence after cf-LVAD implantation according to the AR grading criteria was 37% (203 of 548).…”

“…Six studies provided data on the left ventricular ejection fraction [4,6,[10][11][12][13], and five reported left ventricular end-systolic diameters [7,10,11,13,14]. Six studies published the observed left ventricular end-diastolic diameters [6,7,10,11,13,14]. Briefly, the pooled functional and structural left ventricular data did not show a significant difference between the investigated and control cohorts (left ventricular ejection fraction MD À1.…”

“…Four studies included in the present meta-analysis provided data on blood pressure readings [7,10,12,13]. The data were presented heterogeneously.…”

“…Although heart transplantation outcomes remain benchmarks against which device therapy should be compared, the continuously expanding gap between organ demand and availability has led to both increased numbers of cf-LVAD implantations and longer durations of support [5,6]. As the incidence of de novo AR may increase in parallel to the duration of nonpulsatile flow support, it is clear that this insidious problem may turn out to have widespread negative clinical consequences [4,7].…”

HeartMate 3—a “Step” in the right direction

“…More recent studies have identified lower blood pressure as protective from the development of aortic insufficiency (19). Additionally, strict blood pressure control is increasingly recognized as a therapeutic goal to reduce the rates of hemorrhagic and embolic stroke (20,21).…”