Percutaneous closure of the aortic valve as a bridge to heart transplantation to treat severe aortic insufficiency after ventricular assist device

Sauer, Andrew J.; Davidson, Charles J.

doi:10.1002/ccd.25584

Cited by 5 publications

(2 citation statements)

References 7 publications

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“…Reoperative aortic valve surgery and its attendant risks have led surgeons to search for less‐invasive methods to address AI. Percutaneous valve closure with Amplatzer Occluders (St. Jude Medical) have been used successfully, but are associated with some residual valve regurgitation and hemolysis . Furthermore, closure of the aortic valve potentially creates a life‐threatening condition if the LVAD has a mechanical failure.…”

Section: Discussionmentioning

confidence: 99%

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Transcatheter aortic valve repair for management of aortic insufficiency in patients supported with left ventricular assist devices

et al. 2016

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The development of new aortic insufficiency after a period of support with a left ventricular assist device can result in progressive heart failure symptoms. Transcatheter aortic valve repair can be an effective treatment in selected patients, but the lack of aortic valve calcification can result in unstable prostheses or paravalvular leak. We describe a technique of deploying a self-expanding CoreValve (Medtronic, Minneapolis, MN, USA) into the aortic annulus, followed by a balloon-expandable SAPIEN-3 (Edwards, Irvine, CA, USA).

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Section: Discussionmentioning

confidence: 99%

“…Surgical correction of aortic valve insufficiency can result in hemodynamic stabilization and resolve symptoms . However, reoperative aortic valve surgery in these patients involves significant risk, and alternative repair mechanisms have been described …”

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confidence: 99%

Transcatheter aortic valve repair for management of aortic insufficiency in patients supported with left ventricular assist devices

et al. 2016

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Challenges faced in long term ventricular assist device support

Ikegami

Kurlansky

Takeda

et al. 2016

Expert Review of Medical Devices

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This review will discuss quality of life, survival, and clinically encountered complications in patients with VAD support. The literature was extensively reviewed for studies describing the above topic area. We describe the impact of major challenges faced in VAD support and discuss their future and expectations. Expert commentary: The technological advancement of VADs has contributed to major improvement of overall survival, enhancement of quality of life and decrease of incidence of complications. It is expected that technologies will continue to evolve. At the same time, the indications for and timing of device implantation, and selection of device type are continuously important in clinical practice setting.

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Percutaneous Transcatheter Interventions for Aortic Insufficiency in Continuous-Flow Left Ventricular Assist Device Patients: A Systematic Review and Meta-Analysis

Phan¹,

Haswell

et al. 2017

ASAIO Journal

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De novo progressive aortic insufficiency (AI) is a side effect frequently related to prolonged support with continuous-flow left ventricular assist devices (CF-LVAD). Its progression can result in recurrent clinical heart failure symptoms and significantly increased mortality. Recently, percutaneous intervention methods, such as transcatheter aortic valve replacement (TAVR) and percutaneous occluder devices, have emerged. However, given the very scarce global experience with these approaches, evidence in the literature is lacking. We sought to assess the outcomes of CF-LVAD patients who had undergone percutaneous intervention for AI. A systematic search of six databases from inception to April 2016 was performed by two independent reviewers. Eligible studies were those that included series or cases where patients had percutaneous transcatheter interventions for AI in CF-LVAD patients. Data were extracted and meta-analyzed from the identified studies. A total of 29 patients from 15 published studies and 3 unpublished records were included in the analysis. Mean patient age was 56.6 ± 13.7 years, and 72.4% were male. The etiology of heart failure resulting in LVAD placement was ischemic cardiomyopathy in 17.2%. The two intervention groups were TAVR (27.6%) and occluder devices (72.4%). A transfemoral approach (69%), apical approach (10%), brachial approach (7%), subclavian approach (3%), and mini-sternotomy (3%) were used. The preintervention AI grade was severe with a median grade of 4 (interquartile range, 4-4). Postoperatively, the AI grade improved significantly to a median grade of 0 (0-2). At long-term follow-up AI grade was still trivial with a median AI grade of 1 (0-1). Subgrouping the treatments into the occluder device and TAVR, it was found that both interventional techniques were similarly effective in reducing the AI grade from severe to trivial. In terms of complications, from the occluder group, two patients were complicated with device migration and another two with transient hemolysis. In the TAVR cohort, two patients experienced device migration and another had significant postimplant perivalvular leakage. Our results indicate that percutaneous interventions for AI in CF-LVAD patients with TAVR, and closure devices demonstrate similar efficacy in significantly reducing severe AI. Current results are encouraging, potentiating viability as a treatment option, particularly in nonsurgical candidates. Future research with larger patient cohorts and comparative controls is required to sufficiently evaluate the efficacy of this technique and promote its widespread acceptance as a mainstay treatment.

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Percutaneous closure of the aortic valve as a bridge to heart transplantation to treat severe aortic insufficiency after ventricular assist device

Cited by 5 publications

References 7 publications

Transcatheter aortic valve repair for management of aortic insufficiency in patients supported with left ventricular assist devices

Transcatheter aortic valve repair for management of aortic insufficiency in patients supported with left ventricular assist devices

Challenges faced in long term ventricular assist device support

Percutaneous Transcatheter Interventions for Aortic Insufficiency in Continuous-Flow Left Ventricular Assist Device Patients: A Systematic Review and Meta-Analysis

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