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Aortic Insufficiency in Patients With Sustained Left Ventricular Systolic Dysfunction After Axial Flow Assist Device Implantation.
MedLine Citation:
PMID:  25381791     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background:Predicting the occurrence of aortic insufficiency (AI) during left ventricular assist device (LVAD) support has remained unsolved.Methods and Results:We enrolled 52 patients who had received continuous flow LVAD (14 axial and 38 centrifugal pumps) and who been followed for ≥6 months between Jun 2006 and Dec 2013. Native aortic valve (AV) opening was observed in 18 patients (35%) with improved LV systolic function, and none of them had AI. On multivariate logistic regression analysis preoperative shorter heart failure duration was the only independent predictor of postoperative native AV opening (P=0.042; odds ratio [OR], 0.999). Of the remaining 34 patients (65%) with closed AV, 11 had AI with enlargement of the aortic root and narrow pulse pressure. Among those with closed AV, axial pump use (n=13) was the only significant predictor of the development of AI (P=0.042; OR, 4.950). Patients with AI had lower exercise capacity and a higher readmission rate than those without AI during 2-year LVAD support (55% vs. 8%; P<0.001).Conclusions:Native AV opening during LVAD support is profoundly associated with reversal of LV systolic function, especially in patients with preoperative shorter heart failure duration. Among those in whom the native AV remains closed, low pulsatility of axial flow pump may facilitate aortic root remodeling and post-LVAD AI development that results in worse clinical outcome.
Authors:
Teruhiko Imamura; Koichiro Kinugawa; Takeo Fujino; Toshiro Inaba; Hisataka Maki; Masaru Hatano; Osamu Kinoshita; Kan Nawata; Shunei Kyo; Minoru Ono
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-07
Journal Detail:
Title:  Circulation journal : official journal of the Japanese Circulation Society     Volume:  -     ISSN:  1347-4820     ISO Abbreviation:  Circ. J.     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-10     Completed Date:  -     Revised Date:  2014-11-11    
Medline Journal Info:
Nlm Unique ID:  101137683     Medline TA:  Circ J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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