Author + information
- Received May 30, 2018
- Revision received July 19, 2018
- Accepted July 24, 2018
- Published online October 29, 2018.
- Lauren K. Truby, MDa,
- A. Reshad Garan, MDa,
- Raymond C. Givens, MD, PhDa,
- Brian Wayda, MDa,
- Koji Takeda, MD, PhDb,
- Melana Yuzefpolskaya, MDa,
- Paolo C. Colombo, MDa,
- Yoshifumi Naka, MD, PhDb,
- Hiroo Takayama, MD, PhDb and
- Veli K. Topkara, MD, MSca,∗ ()
- aDivision of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- bDivision of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
- ↵∗Address for correspondence:
Dr. Veli K. Topkara, Center for Advanced Cardiac Care, Columbia University Medical Center-New York Presbyterian, 622 West 168th Street, PH10-203A, New York, New York 10032.
Objectives This study sought to evaluate the impact of moderate to severe aortic insufficiency (AI) on outcomes in patients with continuous flow left ventricular assist devices (CF-LVADs).
Background Development of worsening AI is a common complication of prolonged CF-LVAD support and portends poor prognosis in single-center studies. Predictors of worsening AI and its impact on clinical outcomes have not been examined in a large cohort.
Methods We conducted a retrospective analysis of patients with CF-LVAD in the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) study. Development of significant AI was defined as the first instance of at least moderate AI. Primary outcomes of interest were survival after development of significant AI and time to adverse events, including device complications and rehospitalizations.
Results Among 10,603 eligible patients, 1,399 patients on CF-LVAD support developed moderate to severe AI. Prevalence of significant AI progressively increased over time. Predictors of worsening AI included older age, female sex, smaller body mass index, mild pre-implantation AI, and destination therapy strategy. Moderate to severe AI was associated with significantly higher left ventricular end-diastolic diameter, reduced cardiac output, and higher levels of brain natriuretic peptide. Significant AI was associated with higher rates of rehospitalization (32.1% vs. 26.6%, respectively, at 2 years; p = 0.015) and mortality (77.2% vs. 71.4%, respectively, at 2 years; p = 0.005), conditional upon survival to 1 year.
Conclusions Development of moderate to severe AI has a negative impact on hemodynamics, hospitalizations, and survival on CF-LVAD support. Pre- and post-implantation management strategies should be developed to prevent and treat this complication.
Supported by National Center for Advancing Translational Sciences, National Institutes of Health grants UL1TR001873 (to Dr. Topkara) and KL2TR001874 (to Dr. Garan), and Lisa and Mark Schwartz, and Program to Reverse Heart Failure, New York Presbyterian Hospital-Columbia University. Dr. Colombo has consulted for and received research support from Abbott. Dr. Naka has consulted for Thoratec and Heartware. All other authors have reported that they have no industrial relationships relevant to the contents of this paper to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) or National Institutes of Health.
- Received May 30, 2018.
- Revision received July 19, 2018.
- Accepted July 24, 2018.
- 2018 American College of Cardiology Foundation
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