Aortic Insufficiency and Hemocompatibility-related Adverse Events in Patients with Left Ventricular Assist Devices.
- 2019
AIM: Hemocompatibility-related adverse events (HRAE) are a major cause of readmissions in patients with left ventricular assist device (LVAD). The impact of aortic insufficiency (AI) on HRAE remains uncertain. We aimed to investigate the impact of AI on HRAE. CONCLUSION: Significant AI, as assessed by Doppler echocardiographic parameters, was associated with HRAE during LVAD support. Copyright (c) 2019. Published by Elsevier Inc. METHODS AND RESULTS: Patients who underwent LVAD implantation between August 2014 and July 2017 and had echocardiograms 3 months post-LVAD were enrolled. AI severity was assessed by measuring the systolic/diastolic ratio of flow and the rate of diastolic flow acceleration using Doppler echocardiography of the outflow cannula. Regurgitation fraction (RF) was derived from these parameters. Significant AI was defined as RF >30%. Among 105 patients (median age 56 years, 76% male), 36 patients (34%) had significant AI. Baseline characteristics were statistically not significantly different between those with and without significant AI except for higher rates of ischemic etiology and atrial fibrillation in the significant AI group (p <0.05 for both). One-year survival free from HRAE was 44% in patients with AI compared to 67% in patients without significant AI (p=0.018). The average hemocompatibility score, which defines the net burden of HRAE, was higher in the AI group (1.72 vs. 0.64; p=0.009), mostly due to higher tier I (mild HRAE; p=0.034) and tier IIIB scores (severe HRAE; p=0.011).