Key result
Surgical interventions (aortic valve replacement or repair) for late aortic regurgitation in patients with a continuous flow-LVAD showed no significant difference in 5-year overall survival (p=0.86).
Why the study?
Outcomes of surgical interventions, including aortic valve replacement and repair, for symptomatic moderate-to-severe aortic regurgitation in patients with continuous flow-left ventricular assist devices needed investigation.
Do surgical interventions for late aortic regurgitation provide safe and effective outcomes in patients with continuous flow-left ventricular assist devices?
Cohort (n=184)
Do surgical interventions for late aortic regurgitation provide safe and effective outcomes in patients with continuous flow-left ventricular assist devices?
Surgical interventions (AVR or AVP) for symptomatic moderate-to-severe aortic regurgitation in patients with an ongoing cf-LVAD are safe and viable options that do not negatively impact overall 5-year survival.
This study aimed to investigate the outcomes of surgical interventions for symptomatic moderate-to-severe aortic regurgitation (AR), including aortic valve replacement (AVR) and repair (AVP), in 184 patients who underwent continuous flow-left ventricular assist device (Cf-LVAD) implantation as a bridge-to-transplant (BTT) between November 2007 and April 2020. Ten patients (median age, 34 (25–41) years; 60% men) underwent surgical interventions (AVR, n = 6; AVP, n = 4) late after cf-LVAD implantation. The median duration after the device implantation was 34 (24–44) months. Three patients required additional tricuspid valve repair. Aortic valve suturing resulted in severe recurrent AR 6 months postoperatively, due to leaflet cutting in one patient. Seven patients with AVR survived without regurgitation during the study period, except for one non-survivor complicated by liver failure due to postoperative right heart failure. Therefore, six patients after AVP (n = 4) and AVR (n = 2) underwent successful heart transplantation 7 (4–13) months after aortic intervention. Kaplan–Meier analysis showed no significant difference in overall survival through 5 years after cf-LVAD implantation, regardless of the surgical AV intervention chosen (log-rank test, p = 0.86). In conclusion, surgical interventions (AVR or AVP) for patients with an ongoing cf-LVAD are safe, effective, and viable options.
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Gyoten et al. (2022) conducted a cohort in Symptomatic moderate-to-severe aortic regurgitation associated with continuous flow-left ventricular assist device therapy (n=184). Surgical interventions (aortic valve replacement or repair) vs. Other surgical AV intervention or no intervention was evaluated on Overall survival through 5 years after cf-LVAD implantation (p=0.86). Surgical interventions (aortic valve replacement or repair) for late aortic regurgitation in patients with a continuous flow-LVAD showed no significant difference in 5-year overall survival (p=0.86).
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