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Surgical correction of aortic valve insufficiency after left ventricular assist device implantation.

Publication ,  Journal Article
Atkins, BZ; Hashmi, ZA; Ganapathi, AM; Harrison, JK; Hughes, GC; Rogers, JG; Milano, CA
Published in: J Thorac Cardiovasc Surg
November 2013

OBJECTIVES: New-onset aortic insufficiency (AI) can be encountered after instituting mechanical circulatory support and seems more common and severe with continuous flow (CF) left ventricular assist devices (LVADs) compared with pulsatile devices. Treatment algorithms for de novo, post-LVAD AI have not been well defined. In the present report, we have described 6 patients who underwent aortic valve surgery for new-onset post-LVAD AI. METHODS: From 2005 to 2011, 271 patients underwent LVAD implantation. Of these LVADs, 225 were CF devices (203 HeartMate II devices, Thoratec Corp, Pleasanton, Calif; and 22 HVAD devices, HeartWare Intl, Inc, Framingham, Mass). The patients were examined for new-onset severe AI requiring surgical intervention. RESULTS: During follow-up, 6 CF LVAD patients developed new, severe AI that was accompanied by heart failure. After medical therapy had failed, 4 patients underwent redo sternotomy for aortic valve procedures (1 bioprosthetic valve replacement, 1 Dacron patch closure, and 2 aortic valve repairs), and 2 patients underwent transcatheter aortic valve procedure, with 1 requiring revision by open surgery for aortic valve replacement. Of the 6 patients, 5 experienced significant improvement in functional capacity and symptoms. One patient died postoperatively secondary to multiorgan failure and sepsis. CONCLUSIONS: Surgical treatment of post-LVAD AI with aortic valve oversewing or leaflet repair or by bioprosthetic aortic valve replacement is effective at restoring functional capacity for CF LVAD patients who develop symptomatic, severe AI and can be performed safely with good results. Various transcatheter approaches to these difficult problems are also available and offer less invasive alternatives to conventional surgery.

Duke Scholars

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

November 2013

Volume

146

Issue

5

Start / End Page

1247 / 1252

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Treatment Outcome
  • Suture Techniques
  • Sternotomy
  • Severity of Illness Index
  • Respiratory System
  • Reoperation
  • Recovery of Function
  • Prosthesis Design
  • Male
 

Citation

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Atkins, B. Z., Hashmi, Z. A., Ganapathi, A. M., Harrison, J. K., Hughes, G. C., Rogers, J. G., & Milano, C. A. (2013). Surgical correction of aortic valve insufficiency after left ventricular assist device implantation. J Thorac Cardiovasc Surg, 146(5), 1247–1252. https://doi.org/10.1016/j.jtcvs.2013.05.019
Atkins, B Zane, Zubair A. Hashmi, Asvin M. Ganapathi, J Kevin Harrison, G Chad Hughes, Joseph G. Rogers, and Carmelo A. Milano. “Surgical correction of aortic valve insufficiency after left ventricular assist device implantation.J Thorac Cardiovasc Surg 146, no. 5 (November 2013): 1247–52. https://doi.org/10.1016/j.jtcvs.2013.05.019.
Atkins BZ, Hashmi ZA, Ganapathi AM, Harrison JK, Hughes GC, Rogers JG, et al. Surgical correction of aortic valve insufficiency after left ventricular assist device implantation. J Thorac Cardiovasc Surg. 2013 Nov;146(5):1247–52.
Atkins, B. Zane, et al. “Surgical correction of aortic valve insufficiency after left ventricular assist device implantation.J Thorac Cardiovasc Surg, vol. 146, no. 5, Nov. 2013, pp. 1247–52. Pubmed, doi:10.1016/j.jtcvs.2013.05.019.
Atkins BZ, Hashmi ZA, Ganapathi AM, Harrison JK, Hughes GC, Rogers JG, Milano CA. Surgical correction of aortic valve insufficiency after left ventricular assist device implantation. J Thorac Cardiovasc Surg. 2013 Nov;146(5):1247–1252.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

November 2013

Volume

146

Issue

5

Start / End Page

1247 / 1252

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Treatment Outcome
  • Suture Techniques
  • Sternotomy
  • Severity of Illness Index
  • Respiratory System
  • Reoperation
  • Recovery of Function
  • Prosthesis Design
  • Male