Modified Central Closure Technique for Treatment of Aortic Insufficiency in Patients on Left Ventricular Assist Device Support

Development of aortic insufficiency (AI) in a patient with a continuous flow left ventricular assist device (CF-LVAD) represents a serious complication. The circulatory loop that is created by the AI can lead to cardiogenic shock, malperfusion, and multisystem organ failure. The central closure technique has been well described and is a popular method of repairing the aortic valve in CF-LVAD patients with AI. Because of an early failure using this technique, we developed a modification of this technique that we describe in this report that can be particularly useful when the aortic valve leaflet tissue is relatively normal or thin, as opposed to thickened/fibrosed, as the strength of the repair is not solely provided by the central coaptation point of the leaflets, but is rather, distributed more diffusely across the leaflets.