Impact of progressive aortic regurgitation on outcomes after left ventricular assist device implantation

Hrvoje Gasparovic*, Nina Jakus, Jasper J. Brugts, Anne Catherine Pouleur, Philippe Timmermans, Pawel Rubiś, Edvinas Gaizauskas, Emeline M. Van Craenenbroeck, Eduardo Barge-Caballero, Sebastian Grundmann, Stefania Paolillo, Domenico D’Amario, Oscar Braun, Bart Meyns, Walter Droogne, Karol Wierzbicki, Katarzyna Holcman, Ivo Planinc, Daniel Lovric, Andreas J. FlammerMate Petricevic, Bojan Biocina, Lars H. Lund, Davor Milicic, Frank Ruschitzka, Maja Cikes

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Aortic regurgitation (AR) following continuous flow left ventricular assist device implantation (cf-LVAD) may adversely impact outcomes. We aimed to assess the incidence and impact of progressive AR after cf-LVAD on prognosis, biomarkers, functional capacity and echocardiographic findings. In an analysis of the PCHF-VAD database encompassing 12 European heart failure centers, patients were dichotomized according to the progression of AR following LVAD implantation. Patients with de-novo AR or AR progression (AR_1) were compared to patients without worsening AR (AR_0). Among 396 patients (mean age 53 ± 12 years, 82% male), 153 (39%) experienced progression of AR over a median of 1.4 years on LVAD support. Before LVAD implantation, AR_1 patients were less frequently diabetic, had lower body mass indices and higher baseline NT-proBNP values. Progressive AR did not adversely impact mortality (26% in both groups, HR 0.91 [95% CI 0.61–1.36]; P = 0.65). No intergroup variability was observed in NT-proBNP values and 6-minute walk test results at index hospitalization discharge and at 6-month follow-up. However, AR_1 patients were more likely to remain in NYHA class III and had worse right ventricular function at 6-month follow-up. Lack of aortic valve opening was related to de-novo or worsening AR (P < 0.001), irrespective of systolic blood pressure (P = 0.67). Patients commonly experience de-novo or worsening AR when exposed to continuous flow of contemporary LVADs. While reducing effective forward flow, worsening AR did not influence survival. However, less complete functional recovery and worse RV performance among AR_1 patients were observed. Lack of aortic valve opening was associated with progressive AR.

Original languageEnglish
Pages (from-to)1985-1994
Number of pages10
JournalHeart and Vessels
Volume37
Issue number12
DOIs
Publication statusPublished - 23 Jun 2022

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Publisher Copyright: © 2022, Springer Japan KK, part of Springer Nature.

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