Long-term Outcome of Concomitant Aortic Valve Repair in Patients with Continuous-Flow Left Ventricular Assist Device
Presented During:
Monday, April 29, 2024: 2:00PM - 2:15PM
Metro Toronto Convention Center
Posted Room Name:
Room 717
Abstract No:
267
Submission Type:
Abstract Submission
Authors:
Melissa Hynds (1), Hideyuki Hayashi (1), Paul Kurlansky, MD (1), Yanling Zhao (1), Alice Vinogradsky (1), Melana Yuzefpolskaya (1), Paolo Colombo (1), Gabriel Sayer (1), Nir Uriel (1), Yoshifumi Naka (2), Koji Takeda (1)
Institutions:
(1) Columbia University Irving Medical Center, New York, NY, (2) Weill Cornell Medical Center, New York, NY
Submitting Author:
Melissa Hynds
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Co-Author(s):
Hideyuki Hayashi
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
*Paul Kurlansky, MD
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Yanling Zhao
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Alice Vinogradsky
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Melana Yuzefpolskaya
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Paolo Colombo
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Gabriel Sayer
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Nir Uriel
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
*Yoshifumi Naka
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Weill Cornell Medical Center
Weill Cornell Medical Center
*Koji Takeda
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Presenting Author:
Melissa Hynds
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Columbia University
Columbia University
Abstract:
Objective: Our objective was to analyze the development of aortic insufficiency (AI) in patients who received central aortic valve repair (AVr) when undergoing continuous-flow left ventricular assist device (CF-LVAD) implantation.
Methods: We conducted a retrospective review of patients who underwent HeartMate (HM) 2 or 3 implantation between 2004 and 2022. Eighty-nine patients were excluded from analysis for history of aortic valve (AV) procedures, a bicuspid AV, other concomitant AV procedure or limited follow-up echocardiographic data. Patients who had ≥ mild AI had concomitant AVr. Clinical characteristics, serial echocardiograms, and outcomes were determined.
Results: Of the 656 patients who underwent HM3/HM2 LVAD implantation, 110 patients (62 HM2 and 48 HM3) underwent AVr. Median age for AVr patients was 68 years [60-73 years], 91.8% [n=101] were male, 55.6% [n=60] were white, and 70% [n=77] received HM2/3 as DT therapy. In hospital mortality was 6.4% [n=7]. Figures showed severity of AI from preop to follow up (A) and cumulative incidence of moderate or greater AI (B). Freedom from ≥ moderate AI was 98% (± 0.01), 94.9% (± 0.03), and 92.8% (± 0.03) at 1-year, 2-year, and 3-year post-implantation, respectively. One HM2 patient experienced severe AI and left ventricular dilation at 1 month and was treated with a heart transplant 44 days after the echocardiographic measurement. Three-year survival was 64.5% [95% CI, 52.2-74.3%].
Conclusions: AVr may be an effective technique to mitigate AI in HM2 and HM3. A larger cohort study with longer duration of follow up is warranted to further investigate the clinical impact.
Methods: We conducted a retrospective review of patients who underwent HeartMate (HM) 2 or 3 implantation between 2004 and 2022. Eighty-nine patients were excluded from analysis for history of aortic valve (AV) procedures, a bicuspid AV, other concomitant AV procedure or limited follow-up echocardiographic data. Patients who had ≥ mild AI had concomitant AVr. Clinical characteristics, serial echocardiograms, and outcomes were determined.
Results: Of the 656 patients who underwent HM3/HM2 LVAD implantation, 110 patients (62 HM2 and 48 HM3) underwent AVr. Median age for AVr patients was 68 years [60-73 years], 91.8% [n=101] were male, 55.6% [n=60] were white, and 70% [n=77] received HM2/3 as DT therapy. In hospital mortality was 6.4% [n=7]. Figures showed severity of AI from preop to follow up (A) and cumulative incidence of moderate or greater AI (B). Freedom from ≥ moderate AI was 98% (± 0.01), 94.9% (± 0.03), and 92.8% (± 0.03) at 1-year, 2-year, and 3-year post-implantation, respectively. One HM2 patient experienced severe AI and left ventricular dilation at 1 month and was treated with a heart transplant 44 days after the echocardiographic measurement. Three-year survival was 64.5% [95% CI, 52.2-74.3%].
Conclusions: AVr may be an effective technique to mitigate AI in HM2 and HM3. A larger cohort study with longer duration of follow up is warranted to further investigate the clinical impact.
ADULT CARDIAC:
Cardiac Transplant and Mechanical Circulatory Support
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