267. Long-term Outcome of Concomitant Aortic Valve Repair in Patients with Continuous-Flow Left Ventricular Assist Device
University of Virginia
Charlottesville, VA
United States - Contact Me
Leora Yarboro is an Associate Professor with Tenure and Chief of the Section of Cardiac Surgery at the University of Virginia. She maintains a comprehensive, high-acuity surgical practice with expertise in advanced heart failure surgeries, including mechanical circulatory support and heart transplantation.
Columbia University
Bronx, NY
United States - Contact Me
Melissa Hynds is a second-year medical student at Columbia University Vagelos College of Physicians and Surgeons. She was born and raised in the Bronx, New York. Before starting medical school, she graduated with honors from Johns Hopkins University with bachelor's degrees in Medicine, Science and the Humanities and in Natural Sciences with a concentration in Biology. Prior to medical school, her research focused on understanding chemotherapy and immunotherapy resistance and relapse in pediatric leukemia patients. Now, her research in cardiothoracic surgery focuses on clinical outcomes in heart failure, heart valve repairs, and mechanical circulatory support under the mentorship of Dr. Koji Takeda.
Description
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.
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