Development of de novo aortic valve incompetence in patients with the continuous-flow HeartWare ventricular assist device

• Published in: The Journal of heart and lung transplantation Vol. 35; no. 3; pp. 312 - 319
• Main Authors: Bhagra, Sai, MRCP, Bhagra, Catriona, MD, Özalp, Faruk, MRCS, Butt, Tanveer, FRCS, Ramesh, B.C., FRCS, Parry, Gareth, FRCP, Roysam, Chandrika, FRCA, Woods, Andrew, BSc, Robinson-Smith, Nicola, BA, Wrightson, Neil, BSc, MacGowan, Guy A., MD, Schueler, Stephan, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2016
• Subjects: aortic incompetence; aortic regurgitation; aortic root; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - etiology; echocardiogram; Echocardiography; Female; Heart-Assist Devices - adverse effects; HeartWare; Humans; HVAD; Male; Middle Aged; Prosthesis Design; Retrospective Studies; Surgery; VAD; aortic root; HVAD; aortic regurgitation; HeartWare; echocardiogram; VAD; aortic incompetence
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2015.10.022

Background In this study we investigated the development of aortic incompetence (AI) and change in aortic root and left ventricular dimensions after implantation of the continuous-flow HeartWare ventricular assist device (HVAD) in our adult patient cohort. Methods A retrospective analysis of serial echocardiograms was performed on patients implanted with an HVAD between July 2009 and July 2013. Data from echocardiograms performed before and at 1 and 2 years (±3 months) were analyzed. Patients with native aortic valves (AoVs) with no previous intervention and HVAD in situ for ≥6 months were included. Results A total of 73 HVADs in 71 patients with a mean duration of support of 624 ± 359 days were included in our study. One patient developed moderate AI at 1 year (1.9%). Mild or greater AI was more likely in those with a closed or intermittently opening AoV at 1 year ( p = 0.005). Aortic annulus dimensions increased significantly at 1 and 2 years, regardless of extent of AI. At 2 years, in those with mild or worse AI, the sinuses of Valsalva were also larger ( p = 0.002). Left ventricular end-diastolic dimension (LVEDD) was significantly reduced in those with no or trace AI at 1 and 2 years ( p = 0.012 and p = 0.008, respectively), but remained unchanged in those with AI at both time-points. Conclusions The development of more than mild AI is rare in HVAD patients at our center. When encountered, it is more common with a closed AoV. Dilation of the aortic annulus, and root dilation in those with mild or more AI, is seen with HVAD support over time.