Fusion of Aortic Valve Commissures in Patients Supported by a Continuous Axial Flow Left Ventricular Assist Device

Mudd, James O.; Cuda, Jonathan D.; Halushka, Marc K.; Soderlund, Karl A.; Conte, John V.; Russell, Stuart D.

doi:10.1016/j.healun.2008.05.029

Cited by 175 publications

(121 citation statements)

References 17 publications

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“…8,11, 12 The incidence of AI development was much higher and the average time to develop AI was longer in our study than in the Columbia study. 8 The discrepancy is partly explained by differences in the device types and/or the grading of AI, but if they had observed for a more extended period as we did, more patients might have developed AI.…”

Section: Discussionmentioning

confidence: 40%

“…Commissural fusion appears to be associated with myxoid thickening without any evidence of inflammation. 12 In the patient presented in Figure 3, we consistently observed commissural fusion macroscopically, which was able to be released easily by the operator's fingers, suggesting no evidence of valvulitis. The development of AI could be attributed to the fusion of 1 or 2 commissures, 7,12 but this type of fusion does not always accompany AI in LVAD patients.…”

Section: Discussionmentioning

confidence: 65%

“…8,11, 12 Furthermore, most of the reports were based on trials for bridge-to-transplantation and few patients were followed for more than 1 year because the average bridging period to transplantation was approximately 3 months in the USA. We report here that postoperative AI can occur in the patients implanted with the extracorporeal pulsatile TOYOBO pump.…”

mentioning

confidence: 99%

“…The prevalence of postoperative AI increases in a time-dependent manner, 8, 11 and AI is likely to be irreversible and often progressive once it develops. 11, 12 Therefore, AI is an important complication of destination therapy because such patients are generally supported for longer period than those who are eligible for transplantation. As a result of donor shortage, our observation period 2 was comparable to or even longer than that of trials of destination therapy, 13, 14 and we believe that our study is also able to provide information applicable to patients for the destination therapy.…”

mentioning

confidence: 99%

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Less Frequent Opening of the Aortic Valve and a Continuous Flow Pump Are Risk Factors for Postoperative Onset of Aortic Insufficiency in Patients With a Left Ventricular Assist Device

Hatano

Kinugawa

Shiga

et al. 2011

Circ J

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Background: Postoperative development of aortic insufficiency (AI) after implantation of left ventricular assist devices (LVADs) has recently been recognized, but the devices in the previous reports have been limited to the HeartMate I or II. The purposes of this study were to determine whether AI develops with other types of LVADs and to elucidate the factors associated with the development of AI. Methods and Results:Thirty-seven patients receiving LVADs without evident abnormalities in native aortic valves were enrolled (pulsatile flow LVAD [TOYOBO]: 76%, continuous flow LVAD [EVAHEART, DuraHeart, Jarvik2000, HeartMate II]: 24%). Frequency of aortic valve opening and grade of AI were evaluated by the most recent echocardiography during LVAD support. None of the patients had more than trace AI preoperatively. During LVAD support AI > -grade 2 developed in 9 patients (24%) across all 5 types of devices. More severe grade of AI correlated with higher plasma B-type natriuretic peptide concentration (r=0.53, P<0.01) and with less frequent of the aortic valve (r=−0.45, P<0.01). Multivariate analysis revealed that lower preoperative left ventricular ejection fraction and a continuous flow device type were independent risk factors for higher incidence of AI.Conclusions: AI, which is hemodynamically significant, develops after implantation of various types of LVADs. Physicians need to be more alert to the development of AI particularly with continuous flow devices. (Circ J 2011; 75: 1147 - 1155

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Section: Discussionmentioning

confidence: 40%

Section: Discussionmentioning

confidence: 65%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Less Frequent Opening of the Aortic Valve and a Continuous Flow Pump Are Risk Factors for Postoperative Onset of Aortic Insufficiency in Patients With a Left Ventricular Assist Device

Hatano

Kinugawa

Shiga

et al. 2011

Circ J

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“…18) A recent meta-analysis revealed that preoperative predictors of AI were higher age and CF LVAD usage. 13) Correlates of development or worsening of AI following LVAD implantation include increasing aortic root diameter, 19,20) less frequent opening of native AV, 19,20,27) AV commissural fusion, 39) higher pump speeds, 19,20) increased mitral regurgitation, 27) and higher levels of B-type natriuretic peptide. 18) We recently proposed a "2-hit theory" for the development of AI ( Figure 3).…”

Section: Previously Reported Predictors Of Post-lvad Aimentioning

confidence: 99%

Preoperative Prediction of Aortic Insufficiency During Ventricular Assist Device Treatment

Imamura

Kinugawa

2016

Int. Heart J.

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SummarySurvival rate in patients with stage D heart failure has improved significantly owing to the development of continuous flow left ventricular assist devices (LVAD), but aortic insufficiency (AI) still remains one of the major unsolved complications that impairs patient quality of life. There are no established treatments for AI, and preoperative prediction and prevention of AI is needed. The opening of a native aortic valve (AV) is a sufficient condition for prevention of AI, and improvement of LV ejection fraction due to LV reverse remodeling (LVRR) is essential to open a native AV. Preoperative insufficient β-blocker treatment and pulsatile flow LVAD usage are keys for LVRR, opening of an AV, and prevention of AI. The second mechanism that leads to AI is remodeling of the aortic root and degeneration of a native AV, which results from reduced pulse pressure during LVAD support. Centrifugal or pulsatile flow LVAD usage has an advantage in terms of preserving pulsatility, and may prevent AI compared with an axial pump. There is less probability of avoiding AI with sufficient β-blocker treatment, and these patients may be good candidates for concomitant surgical intervention to a native AV at the time of LVAD implantation. (Int Heart J 2016; 57: 3-10)Key words: Pulsatility, VAD, Carvedilol, Aortic valve C urrently, the survival rate in patients with advanced heart failure (HF) has improved due to the development of continuous flow (CF) left ventricular assist device (LVAD) treatment and improvement of perioperative management procedures.1-9) However, quality of life during CF LVAD is still not satisfactory because of several unresolved postoperative complications. 4,10,11) One of the major complications is aortic insufficiency (AI), which is characterized as continuous aortic regurgitation during both systolic and diastolic phases through a degenerated and occasionally fusional native aortic valve (AV) ( Figure 1AB). 12,13) Native AV, which is apparently normal before LVAD implantation, can be associated with a considerable level of AI after LVAD implantation. Post-LVAD AI can develop even in the preoperative setting in which there is no aortic regurgitation at all. 12,14,15) In 2000, Rose, et al first documented acquired AV disease during pulsatile flow (PF) LVAD. They identified evidence of commissural fusion of native AV.16) In 2006, Frazier, et al summarized the relationship between commissural fusion of native AV and development of AI during CF LVAD treatment.17) We also showed that AI was more frequently observed in patients with CF LVAD as compared with PF pump in 2011 ( Figure 1C). 18) Since then, a number of single-center studies have documented a wide-ranging prevalence of AI during LVAD treatment. 15,[19][20][21] The development of AI during LVAD treatment is considered to be a multifactorial phenomenon and a result of altered AV and aortic root biomechanics due to chronic and continuous ventricular unloading. Unloading of LV results in ventricular decompression, and the combination of systolic ...

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De Novo Aortic Insufficiency

Cowger

2023

Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease

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Fusion of Aortic Valve Commissures in Patients Supported by a Continuous Axial Flow Left Ventricular Assist Device

Cited by 175 publications

References 17 publications

Less Frequent Opening of the Aortic Valve and a Continuous Flow Pump Are Risk Factors for Postoperative Onset of Aortic Insufficiency in Patients With a Left Ventricular Assist Device

Less Frequent Opening of the Aortic Valve and a Continuous Flow Pump Are Risk Factors for Postoperative Onset of Aortic Insufficiency in Patients With a Left Ventricular Assist Device

Preoperative Prediction of Aortic Insufficiency During Ventricular Assist Device Treatment

De Novo Aortic Insufficiency

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