Impact of Progressive Aortic Regurgitation on Outcomes after Continuous Flow Left Ventricular Assist Device Implantation
PURPOSE: Pancyclic aortic regurgitation (AR) following continuous flow left ventricular assist device implantation (cf-LVAD) adversely impacts device performance. We present the incidence and mortality burden of progressive AR after cf-LVAD placement. METHODS: We conducted a retrospective analysis of a database encompassing the cf-LVAD experience of 12 European centers. Patients were dichotomized according to the progression of AR over time. Patients with de-novo AR or AR progression (group AR were compared to patients without worsening aortic valve function (group AR_0). Clinical and laboratory data were collected and compared between patient groups. Kaplan-Meier analysis was used to evaluate overall survival between cohorts. RESULTS: Out of a total of 372 eligible patients, 147 (40%) have shown progression of AR over a mean follow-up of 3.2±2.6 years. Patients in group AR_1 were comparable to group AR_0 with respect to age (57±11 vs 56±13 yrs, p=0.612), gender (81% vs 82% male, p=0.681) and preoperative INTERMACS profile (2.9±1.2 vs 2.8±1.3, p=0.715), but were found to have a lower body mass index (25±4 vs 26±5, p=0.003) and were less likely to be diabetic (14% vs 27%, P=0.003). Progressive AR did not adversely impact overall survival (Figure). The NT-pro-BNP values at index discharge were similar between groups AR_1 and AR_0 (median 2376 (IQR, 1613-4186) vs 2153 (IQR, 1357-3348), p=0.093) pg/mL and at 6-month follow-up (1632 (IQR, 1031-2567) vs 1460 (795-2331), p=0.455) pg/mL. Six-minute walk test results mirrored these data, with no observable intergroup variability at two time points (368±123 vs 386±139 meters, p=0.480 in groups AR_1 and AR_0) and (415±132 vs 487±55 meters, p=0.068). CONCLUSION: Patients commonly experience worsening AR when exposed to the continuous flow of contemporary LVADs. While harboring potential to reduce effective forward flow by recycling the regurgitant volume, progression of AR in our study did not influence survival or functional status.
|Persistent URL||dx.doi.org/10.1016/j.healun.2020.01.996, hdl.handle.net/1765/127557|
|Journal||The Journal of Heart and Lung Transplantation|
Gasparovic, H. (H.), Jakus, N. (N.), Brugts, J.J, Rubiś, P. (P.), Gaizauskas, E. (E.), Van Craenenbroeck, E.M, … Cikes, M. (M.). (2020). Impact of Progressive Aortic Regurgitation on Outcomes after Continuous Flow Left Ventricular Assist Device Implantation. The Journal of Heart and Lung Transplantation, 39(4), S117–S118. doi:10.1016/j.healun.2020.01.996