The Effects of Percutaneous Left Ventricular Assist Device Placement on Native Valve Competency

Abstract

Impella left ventricular assist devices (LVADs) (Abiomed, Danvers, MA) are implanted in the left ventricle across the aortic valve. Several cases of secondary aortic insufficiency (AI) or mitral regurgitation (MR) after Impella LVAD use have been reported. Secondary valvulopathies can worsen cardiac function. This single center retrospective study sought to characterize the incidence of secondary AI and MR development after Impella LVAD support. One hundred fifty-two patients who underwent Impella LVAD support between April 2014 and August 2019 were included. Patient demographics, implant indications, duration of support, pre- and post-Impella LVAD echocardiograms, and incidence of increased AI/MR were analyzed. Impella 5.0 and Impella CP were subanalyzed. Following exclusion criteria, AI and MR were analyzed in 93 and 78 patients, respectively. An increase in AI and MR was seen in 17.2% and 12.8% of patients with an event per support days of 0.03 and 0.02, respectively. Clinically significant increases in AI and MR were seen in 3.2% (n = 3), 6.4% (n = 5), respectively. The incidences of increased AI (p = 0.33) and MR (p = 0.45) were similar between Impella 5.0 and Impella CP patients. Worsening AI and MR clinically occur at a low incidence with Impella LVAD use. However, careful follow-up is still warranted.

Perioperative Management of Patients Receiving Short-term Mechanical Circulatory Support with the Transvalvular Heart Pump

“…14,37,38 Finally, aortic and mitral valve injury can occur during insertion or manipulation of left-sided devices, leading to clinically significant increases in aortic or mitral regurgitation. 39,40…”

Concomitant or late aortic valve intervention and its efficacy for aortic insufficiency associated with continuous-flow left ventricular assist device implantation

“…As for those who are eligible for heart transplantation, recently they could be directly bridged to transplant with the Impella in the US, as a new status 2 category. However, those who are ineligible for transplant might need to undergo CF-LVAD implantation as destination therapy to survive, and there are several reports on the adverse impact of the Impella on the AV in such patients ( 55 – 58 ). In fact, just on the Impella support, an increase in AI grade was observed in 17.2% of patients with an event per support days of 0.03 ( 55 ).…”

“…However, those who are ineligible for transplant might need to undergo CF-LVAD implantation as destination therapy to survive, and there are several reports on the adverse impact of the Impella on the AV in such patients ( 55 – 58 ). In fact, just on the Impella support, an increase in AI grade was observed in 17.2% of patients with an event per support days of 0.03 ( 55 ). Such a potentially iatrogenic damage on the AV could be associated with AI development even after VAD implants.…”