Progression of aortic valve insufficiency during centrifugal versus axial flow left ventricular assist device support

被引:11
作者
Contreras, Fabian Jimenez [1 ]
Pla, Michelle Mendiola [1 ]
Schroder, Jacob [1 ]
Bryner, Benjamin [1 ]
Agarwal, Richa [2 ]
Russell, Stuart D. [2 ]
Mirza, Jacqueline [1 ]
Daneshmand, Mani A. [3 ]
Milano, Carmelo [1 ]
机构
[1] Duke Univ, Med Ctr, Dept Surg, Div Cardiovasc & Thorac Surg, Durham, NC 27710 USA
[2] Duke Univ, Med Ctr, Div Cardiol, Durham, NC 27710 USA
[3] Emory Univ, Sch Med, Dept Surg, Div Cardiothorac Surg, Atlanta, GA 30322 USA
关键词
Heart failure surgery; Mechanical circulatory assistance; Valve disease; REGURGITATION;
D O I
10.1093/ejcts/ezac087
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES: Long-term left ventricular assist device (LVAD) support can cause accelerated progression of aortic insufficiency (AI). The MOMENTUM trial has led to increased use of the HeartMate 3 (HM3) LVAD, due to greater hemocompatibility. However, the differential effect on the rate of progression of AI during HM3 support versus HeartMate 2 (HM2) has not been extensively studied. This analysis compares the rates of progression to moderate or severe AI (MSAI) comparing a cohort of patients supported with the HM2 versus HM3. METHODS: A retrospective review was performed on all consecutive patients implanted with HM2 or HM3 between May 2005 and June 2020. Follow-up time was limited to the first 6 years after LVAD implantation. Demographics and 4005 echocardiograms were assessed for 536 HM2 and 300 HM3 patients. The primary end point was progression to MSAI. Univariable and multivariable Cox proportional hazard regression and landmark analyses were performed. RESULTS: Progression to MSAI was greater in the HM2 (17%) versus HM3 (9.9%) cohort. On the univariable analysis, the hazard ratio for HM3 was 0.581 (95% confidence interval 0.370-0.909, P = 0.02) whereas on multivariable analysis hazard ratio was 0.624 (95% confidence interval 0.386-1.008, P = 0.0537). Preoperative AI, female sex and body surface area <2 were significantly associated with progression to MSAI. Landmark analysis suggests that LVAD type has the most significant effect on progression to MSAI between 1 and 2 years post-implantation. CONCLUSIONS: Current practice strategies achieved low rates of progression to MSAI. Preoperative AI, female sex and body surface area <2 were the most important predictors of progression to MSAI. Pump type appears to be of secondary importance.
引用
收藏
页码:1188 / 1196
页数:9
相关论文
共 24 条
[1]   The Development of Aortic Insufficiency in Continuous-Flow Left Ventricular Assist Device-Supported Patients [J].
Aggarwal, Ashim ;
Raghuvir, Rashmi ;
Eryazici, Paula ;
Macaluso, Gregory ;
Sharma, Priya ;
Blair, Christopher ;
Tatooles, Antone J. ;
Pappas, Pat S. ;
Bhat, Geetha .
ANNALS OF THORACIC SURGERY, 2013, 95 (02) :493-499
[2]   Selective management strategy of interrupted aortic arch mitigates left ventricular outflow tract obstruction risk [J].
Alsoufi, Bahaaldin ;
Schlosser, Brian ;
McCracken, Courtney ;
Sachdeva, Ritu ;
Kogon, Brian ;
Border, William ;
Mahle, William T. ;
Kanter, Kirk .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2016, 151 (02) :412-U525
[3]   Moderate Aortic Insufficiency with a Left Ventricular Assist Device Portends a Worse Long-Term Survival [J].
Auvil, Bryan ;
Chung, Jennifer ;
Ameer, Alyse ;
Han, Jason ;
Helmers, Mark ;
Birati, Edo ;
Acker, Michael ;
Atluri, Pavan .
ASAIO JOURNAL, 2020, 66 (07) :780-785
[4]   Risk factors for valvular calcification [J].
Chen, Hao Yu ;
Engert, James C. ;
Thanassoulis, George .
CURRENT OPINION IN ENDOCRINOLOGY DIABETES AND OBESITY, 2019, 26 (02) :96-102
[5]   The Development of Aortic Insufficiency in Left Ventricular Assist Device-Supported Patients [J].
Cowger, Jennifer ;
Pagani, Francis D. ;
Haft, Jonathan W. ;
Romano, Matthew A. ;
Aaronson, Keith D. ;
Kolias, Theodore J. .
CIRCULATION-HEART FAILURE, 2010, 3 (06) :668-674
[6]   Influence of aortic valve opening in patients with aortic insufficiency after left ventricular assist device implantation [J].
da Rocha e Silva, Jaqueline G. ;
Meyer, Anna L. ;
Eifert, Sandra ;
Garbade, Jens ;
Mohr, Friedrich W. ;
Strueber, Martin .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2016, 49 (03) :784-787
[7]   Evaluation of the Integrative Algorithm for Grading Chronic Aortic and Mitral Regurgitation Severity Using the Current American Society of Echocardiography Recommendations: To Discriminate Severe from Moderate Regurgitation [J].
Gao, Sinsia A. ;
Polte, Christian L. ;
Lagerstrand, Kerstin M. ;
Johnsson, Ase A. ;
Bech-Hanssen, Odd .
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 2018, 31 (09) :1002-+
[8]   Aortic insufficiency in continuous-flow left ventricular assist device support patients is common but does not impact long-term mortality [J].
Holley, Christopher T. ;
Fitzpatrick, Megan ;
Roy, Samit S. ;
Alraies, M. Chadi ;
Cogswell, Rebecca ;
Souslian, Laura ;
Eckman, Peter ;
John, Ranjit .
JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2017, 36 (01) :91-96
[9]   Impact of worsening of aortic insufficiency during HeartMate 3 LVAD support [J].
Imamura, Teruhiko ;
Narang, Nikhil ;
Kim, Gene ;
Nitta, Daisuke ;
Fujino, Takeo ;
Nguyen, Ann ;
Grinstein, Jonathan ;
Rodgers, Daniel ;
Ota, Takeyoshi ;
Raikhelkar, Jayant ;
Jeevanandam, Valluvan ;
Sayer, Gabriel ;
Uriel, Nir .
ARTIFICIAL ORGANS, 2021, 45 (03) :297-302
[10]  
Interagency Registry for Mechnically Assisted Circulatory Support (INTERMACS), 2021, APP ADV EV DEF AD PE