• Ulrich P Jorde, Nir Uriel, Nadav Nahumi, David Bejar, Jose Gonzalez-Costello, Sunu S Thomas, Jason Han, Kerry A Morrison, Sophie Jones, Susheel Kodali, Rebecca T Hahn, Sofia Shames, Melana Yuzefpolskaya, Paolo Colombo, Hiroo Takayama, and Yoshifumi Naka.
• Divisions of Cardiology and Cardiothoracic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, NY.
• Circ Heart Fail. 2014 Mar 1; 7 (2): 310-9.

BackgroundAortic insufficiency (AI) is increasingly recognized as a complication of continuous flow left ventricular assist device support; however, its long-term prevalence, clinical significance, and efficacy of potential interventions are not well known.Methods And ResultsWe studied the prevalence and management of AI in 232 patients with continuous flow left ventricular assist device at our institution. Patients with aortic valve (AV) surgery before left ventricular assist device implantation were excluded from analysis. To examine the prevalence of de novo AI, patients without preoperative AI were divided into a retrospective and a prospective cohort based on whether a dedicated speed optimization study had been performed at the time of discharge. Forty-three patients underwent AV repair at the time of implant, and 3 subsequently developed greater than mild AI. In patients without surgical AV manipulation and no AI at the time of implant, Kaplan-Meier analysis revealed that freedom from greater than mild de novo AI at 1 year was 77.6±4.2%, and that at least moderate AI is expected to develop in 37.6±13.3% after 3 years. Nonopening of the AV was strongly associated with de novo AI development in patients without prospective discharge speed optimization. Seven of 21 patients with at least moderate AI developed symptomatic heart failure requiring surgical intervention.ConclusionsAI is common in patients with continuous flow left ventricular assist devices and may lead to clinical decompensation requiring surgical correction. The prevalence of AI is substantially less in patients whose AV opens, and optimized loading conditions may reduce AI prevalence in those patients in whom AV opening cannot be achieved.

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