Predictors and Long-Term Impact of De Novo Aortic Regurgitation in Continuous Flow Left Ventricular Assist Devices Using Vena Contracta

被引:1
作者
Park, Jeong Rang [1 ,2 ]
Brady, Peter A. [3 ]
Clavell, Alfredo L. [4 ]
Maleszewski, Joseph J. [5 ]
Nkomo, Vuyisile T. [4 ]
Pislaru, Sorin, V [4 ]
Stulak, John M. [6 ]
Lin, Grace [4 ]
机构
[1] Gyeongsang Natl Univ, Dept Internal Med, Div Cardiol, Sch Med, Jinju, South Korea
[2] Gyeongsang Natl Univ Hosp, Jinju, South Korea
[3] Advocate Illinois Masonic Med Ctr, Dept Cardiol, Chicago, IL USA
[4] Mayo Clin, Dept Cardiovasc Dis, Gonda 6 South,200 First St SW, Rochester, MN 55902 USA
[5] Mayo Clin, Dept Lab Med & Pathol, Rochester, MN 55902 USA
[6] Mayo Clin, Dept Cardiovasc Surg, Rochester, MN 55902 USA
关键词
aortic regurgitation; left ventricular assist device; outcome; AMERICAN SOCIETY; INSUFFICIENCY; MANAGEMENT; SUPPORT; RECOMMENDATIONS; SEVERITY; VALVE; ECHOCARDIOGRAPHY; QUANTIFICATION;
D O I
10.1097/MAT.0000000000001564
中图分类号
R318 [生物医学工程];
学科分类号
0831 ;
摘要
The aim of this study was to identify the optimal echocardiographic measurement of aortic regurgitation (AR) in continuous flow left ventricular assist devices (LVAD) and determine risk factors and clinical implications of de novo AR. Echocardiographic images from consecutive patients who underwent LVAD implantation from February 2007 to March 2017 were reviewed. Severity of de novo AR was determined by vena contracta (VC). Preimplant clinical characteristics, LVAD settings at discharge, and outcomes including heart failure hospitalizations, all-cause mortality, and ventricular arrhythmias of patients with greater than or equal to moderate de novo AR were compared with those with mild or no AR. Among 219 patients, greater than or equal to moderate de novo AR occurred in 65 (29.7%). Left ventricular assist devices support duration was longer with greater than or equal to moderate AR than no or mild AR. In multivariable analysis, preimplant trivial AR and persistent aortic valve (AV) closure were independently associated with de novo AR. By time-varying covariate analysis, survival and freedom from cardiovascular events in greater than or equal to moderate AR were significantly worse (hazard ratio [HR] = 3.947, p < 0.001 and HR = 4.666, p < 0.001). In conclusion, de novo greater than or equal to moderate AR measured by VC increases risk of adverse events. Longer LVAD support duration, preimplant trivial AR, and a closed AV are associated with occurrence of greater than or equal to moderate de novo AR.
引用
收藏
页码:691 / 697
页数:7
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