Key result
Transcatheter aortic valve replacement may be a useful off-label option for managing de novo aortic insufficiency, which develops in up to 30-40% of patients with continuous-flow LVADs.
Why the study?
Surgical aortic valve procedures for de novo aortic insufficiency in continuous-flow LVAD patients are complex and high risk, making TAVR a potential alternative.
Does transcatheter aortic valve replacement (TAVR) provide a viable option for managing de novo aortic insufficiency in patients with a left ventricular assist device?
Does transcatheter aortic valve replacement (TAVR) provide a viable option for managing de novo aortic insufficiency in patients with a left ventricular assist device?
TAVR represents a potential, albeit off-label, less invasive alternative to high-risk surgery for treating de novo aortic insufficiency in patients with continuous-flow LVADs.
May warrant consideration for LVAD-related AI; leaves open need for prospective validation of safety and durability.
Transcatheter aortic valve replacement: A potential option for aortic insufficiency management in patients with left ventricular assist device Left ventricular assist device (LVAD) has become a popular therapeutic option for end stage heart disease (ESHD) [1,2].Initially, this mechanical circulatory assist device was invented for ESHD patients awaiting heart transplant (bridge to transplant or BTT) [2].Indications for using LVAD have expanded and are routinely utilized in heart transplant ineligible ESHD patient as destination therapy (DT).Irrespective of BTT or DT, patients may require LVAD support for an extended duration given wait time for heart transplant [3].Newer generation continuous flow (CF) LVADs have gained popularity because of lesser side effects compared to older pulsatile one [4].However, CF-LVAD has its unique sets of challenges and complications that were not observed with pulsatile LVADs [5].Incidence of denovo aortic insufficiency (AI) in CF-LVAD patients can be as high as 30-40% and worsens with time [6-8].LVAD efficacy diminishes in the presence of moderate to severe AI [7].Surgical closure of the aortic valve (AV) or AV replacement in a patient with LVAD can be highly complex and high risk procedure.Transcatheter AV replacement (TAVR) may be a useful option in this scenario.Though its use for AI is off label, isolated case reports exist.
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Mondal et al. (2019) conducted a review in Aortic insufficiency in patients with left ventricular assist devices. Transcatheter aortic valve replacement (TAVR) was evaluated. Transcatheter aortic valve replacement may be a useful off-label option for managing de novo aortic insufficiency, which develops in up to 30-40% of patients with continuous-flow LVADs.
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