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Predictors and Long-Term Impact of De Novo Aortic Regurgitation in Continuous Flow Left Ventricular Assist Devices Using Vena Contracta

Authors
Park, Jeong RangBrady, Peter A.Clavell, Alfredo L.Maleszewski, Joseph J.Nkomo, Vuyisile T.Pislaru, Sorin, VStulak, John M.Lin, Grace
Issue Date
May-2022
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Keywords
aortic regurgitation; left ventricular assist device; outcome
Citation
ASAIO JOURNAL, v.68, no.5, pp.691 - 697
Indexed
SCIE
SCOPUS
Journal Title
ASAIO JOURNAL
Volume
68
Number
5
Start Page
691
End Page
697
URI
https://scholarworks.bwise.kr/gnu/handle/sw.gnu/1313
DOI
10.1097/MAT.0000000000001564
ISSN
1058-2916
Abstract
The aim of this study was to identify the optimal echocardiographic measurement of aortic regurgitation (AR) in continuous flow left ventricular assist devices (LVAD) and determine risk factors and clinical implications of de novo AR. Echocardiographic images from consecutive patients who underwent LVAD implantation from February 2007 to March 2017 were reviewed. Severity of de novo AR was determined by vena contracta (VC). Preimplant clinical characteristics, LVAD settings at discharge, and outcomes including heart failure hospitalizations, all-cause mortality, and ventricular arrhythmias of patients with greater than or equal to moderate de novo AR were compared with those with mild or no AR. Among 219 patients, greater than or equal to moderate de novo AR occurred in 65 (29.7%). Left ventricular assist devices support duration was longer with greater than or equal to moderate AR than no or mild AR. In multivariable analysis, preimplant trivial AR and persistent aortic valve (AV) closure were independently associated with de novo AR. By time-varying covariate analysis, survival and freedom from cardiovascular events in greater than or equal to moderate AR were significantly worse (hazard ratio [HR] = 3.947, p < 0.001 and HR = 4.666, p < 0.001). In conclusion, de novo greater than or equal to moderate AR measured by VC increases risk of adverse events. Longer LVAD support duration, preimplant trivial AR, and a closed AV are associated with occurrence of greater than or equal to moderate de novo AR.
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의과대학 (의학과)
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