Management of aortic insufficiency in patients with left ventricular assist device ̶ a retrospective analysis

Background: Aortic insufficiency is increasingly recognized as a complication of left ventricular assist device (LVAD) support and may lead to clinical decompensation requiring correction. This article describes experiences in managing patients presenting with concomitant aortic insufficiency and with de novo aortic insufficiency following left ventricular assist device implantations. Methods: All patients undergoing LVAD implantation between 2012 and 2014 were included in this retrospective analysis if aortic valve insufficiency was present on implantation or newly developed (de novo) after implantation. Moderate to severe aortic valve insufficiency was corrected at implantation. Results: The data of 39 patients were included. At the time of LVAD implantation, moderate to severe aortic valve insufficiency was present in 3 patients and was corrected by bioprosthetic valve replacement (2 patients) and by bioprosthetic valve replacement associated with ascending aorta with hemi arch replacement with a graft due to ascending aortic aneurysm (one patient). Four patients developed moderate to severe aortic insufficiency after LVAD surgery. Treatment with conservative medical management was successful in 3 patients. One patient underwent transcatheter aortic valve occlusion using an Amplatzer closure device after failure of medical management. Conclusions: Concomitant aortic valve replacement with LVAD implantation is a safe and viable option in managing aortic valve insufficiency. De novo aortic insufficiency may lead to recurrent heart failure and presents a clinical treatment challenge following successful LVAD support; the most appropriate and effective treatment option awaits definition