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De Novo Aortic Insufficiency During Long-Term Support on a Left Ventricular Assist Device: A Systematic Review and Meta-Analysis

Deo, Salil V.*; Sharma, Vikas; Cho, Yang Hyun,‡; Shah, Ishan K.§; Park, Soon J.

doi: 10.1097/MAT.0000000000000042
Adult Circulatory Support

Aortic insufficiency (AI) may occur while supported on a left ventricular assist device (LVAD). We conducted a systematic review to determine the incidence, predictors, and consequences of AI during LVAD support. MEDLINE was searched for original studies presenting clinical data regarding patients who developed AI during LVAD implant. Seven observational studies (657 patients) were selected for review; 65% of patients underwent implantation with a continuous-flow device (Cf-LVAD). The incidence of AI was 25% (11–42%) (Support period: 412 ± 281 days). AI increased by 4% (1–6%) per month of support (p < 0.01). AI-positive patients were older at implant (weighted mean difference, 7.7 [4.3; 11.1]; p < 0.01). Female sex (0.002 ± 0.001; p = 0.01) and smaller body surface area (−0.003 ± 0.001 per m2; p < 0.01) correlated with progressive AI. Destination therapy patients (odds ratio [OR], 5.3 [1.2, 24]; p = 0.02) and those with Cf-LVAD pumps were likely to develop AI (hazard ratio [HR], 2.2 [1.2, 3.8]; p < 0.01). A closed aortic valve was associated with AI (OR, 4.7 [1.9, 11.8]; p < 0.01). Survival was comparable in both cohorts (HR, 1.5 [0.81, 2.8]; p = 0.2). A significant number of patients develop de novo AI during LVAD support. Advanced age, longer support duration, continuous-flow pumps, and a closed aortic valve are associated with AI. Large cohort studies would improve our understanding of this condition.

From the *Adventist Wockhardt Heart Institute, Surat, Gujarat, India; Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan School of Medicine, Seoul, South Korea; and §Department of Surgery, University of Minnesota, Minneapolis, Minnesota.

Submitted for consideration September 2013; accepted for publication in revised form November 2013.

Disclosure: Dr. SJP is on the advisory committee for Thoratec Corporation. Other authors do not have any disclosures to declare.

Reprint Requests: Soon J. Park, MD, Division of Cardiovascular Surgery, Case Medical Center, Case Western Reserve University, Cleveland OH 44106. Email:

Copyright © 2014 by the American Society for Artificial Internal Organs