De Novo Aortic Insufficiency During Long-Term Support on a Left Ventricular Assist Device
- 1 March 2014
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Asaio Journal
- Vol. 60 (2), 183-188
- https://doi.org/10.1097/mat.0000000000000042
Abstract
Aortic insufficiency (AI) may occur while supported on a left ventricular assist device (LVAD). We conducted a systematic review to determine the incidence, predictors, and consequences of AI during LVAD support. MEDLINE was searched for original studies presenting clinical data regarding patients who developed AI during LVAD implant. Seven observational studies (657 patients) were selected for review; 65% of patients underwent implantation with a continuous-flow device (Cf-LVAD). The incidence of AI was 25% (11-42%) (Support period: 412 ± 281 days). AI increased by 4% (1-6%) per month of support (p < 0.01). AI-positive patients were older at implant (weighted mean difference, 7.7 [4.3; 11.1]; p < 0.01). Female sex (0.002 ± 0.001; p = 0.01) and smaller body surface area (-0.003 ± 0.001 per m; p < 0.01) correlated with progressive AI. Destination therapy patients (odds ratio [OR], 5.3 [1.2, 24]; p = 0.02) and those with Cf-LVAD pumps were likely to develop AI (hazard ratio [HR], 2.2 [1.2, 3.8]; p < 0.01). A closed aortic valve was associated with AI (OR, 4.7 [1.9, 11.8]; p < 0.01). Survival was comparable in both cohorts (HR, 1.5 [0.81, 2.8]; p = 0.2). A significant number of patients develop de novo AI during LVAD support. Advanced age, longer support duration, continuous-flow pumps, and a closed aortic valve are associated with AI. Large cohort studies would improve our understanding of this condition.Keywords
This publication has 19 references indexed in Scilit:
- Durability of left ventricular assist devices: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 2006 to 2011The Journal of Thoracic and Cardiovascular Surgery, 2013
- The Development of Aortic Insufficiency in Continuous-Flow Left Ventricular Assist Device–Supported PatientsThe Annals of Thoracic Surgery, 2013
- Natural history and clinical effect of aortic valve regurgitation after left ventricular assist device implantationThe Journal of Thoracic and Cardiovascular Surgery, 2013
- Late Aortic Insufficiency Related to Poor Prognosis During Left Ventricular Assist Device SupportThe Annals of Thoracic Surgery, 2011
- Less Frequent Opening of the Aortic Valve and a Continuous Flow Pump Are Risk Factors for Postoperative Onset of Aortic Insufficiency in Patients With a Left Ventricular Assist DeviceCirculation Journal, 2011
- The Development of Aortic Insufficiency in Left Ventricular Assist Device-Supported PatientsCirculation: Heart Failure, 2010
- Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devicesThe Journal of Heart and Lung Transplantation, 2010
- Practical methods for incorporating summary time-to-event data into meta-analysisTrials, 2007
- Inclusion of zero total event trials in meta-analyses maintains analytic consistency and incorporates all available dataBMC Medical Research Methodology, 2007
- Extracting summary statistics to perform meta-analyses of the published literature for survival endpointsStatistics in Medicine, 1998