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Long-Term Continuous-Flow Left Ventricular Assist Device Support After Left Ventricular Outflow Tract Closure

Kurihara, Chitaru*,†,‡; Cohn, William E.*,†; Kawabori, Masashi*,†; Sugiura, Tadahisa*,†; Civitello, Andrew B.*,†; Morgan, Jeffrey A.*,†

doi: 10.1097/MAT.0000000000000856
Adult Circulatory Support
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Aortic valve insufficiency can be addressed during continuous-flow left ventricular assist device (CF-LVAD) implantation by performing aortic valve repair or replacement, or patch closure of the left ventricular outflow tract (LVOT). However, few studies have examined the safety of long-term CF-LVAD support after LVOT closure. From November 2003 through March 2016, 16 patients with advanced chronic heart failure underwent CF-LVAD implantation and concomitant LVOT closure for severe aortic insufficiency. We compared their long-term outcomes with those of 510 CF-LVAD recipients without concomitant LVOT closure. Total support time was 26.1 patient-years in the LVOT-closure group and 938.6 patient-years in the CF-LVAD–only group. Survival at 30 days, 6 months, 1 year, and 2 years was similar for CF-LVAD–only patients (90.4%, 80.6%, 74.3%, 67.5%) and LVOT-closure patients (81.3%, 81.3%, 75.0%, 68.8%; p = 0.59). There were no deaths related to LVOT closure. The event rate per patient-year for neurologic dysfunction (ND) was 0.23 in the LVOT-closure group (6 ND events) and 0.20 in the CF-LVAD–only group (136 ND events; p = 0.97). We conclude that for select patients with aortic insufficiency who are undergoing CF-LVAD implantation, LVOT closure produces acceptable outcomes and, therefore, is a viable option.

From the *Division of Cardiothoracic Transplant and Assist Devices, Baylor College of Medicine, Houston, Texas

Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas

Department of Cardiothoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.

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Submitted for consideration October 2017; accepted for publication in revised form June 2018.

Disclosure: The authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Chitaru Kurihara, Texas Heart Institute, Cooley 355N, 6770 Bertner Avenue, Houston, TX 77030. Email: chitaru1207@gmail.com.

Copyright © 2019 by the American Society for Artificial Internal Organs