De Novo Aortic Regurgitation After Continuous-Flow Left Ventricular Assist Device Implantation
Background Significant aortic regurgitation (AR) after continuous-flow left ventricular assist device (cf-LVAD) placement affects device performance and patient outcomes. This study examined the development of AR and long-term results after implantation of cf-LVADs. Methods The study included all pa...
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| Veröffentlicht in: | The Annals of thoracic surgery 2014-09, Vol.98 (3), p.850-857 |
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| creator | Patil, Nikhil Prakash, MRCS, MCh Sabashnikov, Anton, MD Mohite, Prashant N., MRCS, MCh Garcia, Diana, MD Weymann, Alexander, MD Zych, Bartlomiej, MD Bowles, Christopher T., PhD Hards, Rachel, RGN Hedger, Michael, RGN Popov, Aron F., MD De Robertis, Fabio, MD Moza, Ajay, MD Bahrami, Toufan, MD Amrani, Mohamed, MD, PhD Rahman-Haley, Shelley, MD Banner, Nicholas R., FRCP, FESC Simon, André Rüdiger, MD, PhD |
| description | Background Significant aortic regurgitation (AR) after continuous-flow left ventricular assist device (cf-LVAD) placement affects device performance and patient outcomes. This study examined the development of AR and long-term results after implantation of cf-LVADs. Methods The study included all patients with no or less than mild AR who underwent HeartMate II (58 [62%]; Thoratec Corp, Pleasanton, CA) or HeartWare (35 [38%]; HeartWare International, Framingham, MA) implantation at our institute from July 2006 to July 2012. Serial echocardiograms were obtained preoperatively, at 1, 3 and 6 months postoperatively, and then at a minimum of 4-month intervals in patients with longer-term support. Kaplan-Meier estimates for freedom from moderate or greater AR were generated. Logistic regression analysis was used to define independent predictors of AR after cf-LVAD implantation. Results Median duration of LVAD support was 527 days (25th , 75th : 289, 907; range, 60 to 2,433 days). Mild AR developed in 48 patients (51.6%) over a median duration of 126 days, with progression to moderate AR in 13 (14%) over 493 days and to severe AR in 2 (2.1%) over 1,231 days. The incidence of mild or greater AR was 43.1% in HeartMate II vs 65.7% in HeartWare recipients ( p = 0.035). Overall freedom from moderate or greater AR was 94.7% ± 2.6% at 1 year, 86.9% ± 4.5% at 2 years, 82.8% ± 5.9% at 3 years, and 31% ± 16.9% at 4 years. Independent predictors of AR were duration of support (odds ratio, 1.002; 95% confidence interval, 1.000 to 1.004; p = 0.017) and a persistently closed aortic valve (odds ratio, 0.193; 95% confidence interval, 0.097 to 0.382; p |
| doi_str_mv | 10.1016/j.athoracsur.2014.05.030 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1560579402</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0003497514010820</els_id><sourcerecordid>1560579402</sourcerecordid><originalsourceid>FETCH-LOGICAL-c528t-fde68484c19c1720dd719f6c094deea6366f111447cb54339d7eb11c2c292f823</originalsourceid><addsrcrecordid>eNqNkc9u1DAQxi0EotvCKyAfuSQdO7aTXJCWLS2VVlTi39XyOpPiJRsvtrOob8Oz9MnqaAtInDiNRvPNNzO_IYQyKBkwdb4tTfrmg7FxCiUHJkqQJVTwhCyYlLxQXLZPyQIAqkK0tTwhpzFuc8pz-Tk54RJUqxq5IPoC6Qd_8HTpQ3KWfsTbKdy6ZJLzI132CQNd-TG5cfJTLC4H_5OusU_0K44pODsNJtBljC4meoEHZ_H-1_VuP5jxaPGCPOvNEPHlYzwjXy7ffV69L9Y3V9er5bqwkjep6DtUjWiEZa1lNYeuq1nbKwut6BCNqpTqGWNC1HYjRVW1XY0bxiy3vOV9w6sz8vrouw_-x4Qx6Z2LFoe8CObFNZMKZN0KmKXNUWqDjzFgr_fB7Uy40wz0jFdv9V-8esarQeqMN7e-epwybXbY_Wn8zTML3h4FmG89OAw6Woejxc4FtEl33v3PlDf_mNjBjc6a4TveYdz6KYyZpWY6cg360_zm-ctMAIOGQ_UASkmnIA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1560579402</pqid></control><display><type>article</type><title>De Novo Aortic Regurgitation After Continuous-Flow Left Ventricular Assist Device Implantation</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Patil, Nikhil Prakash, MRCS, MCh ; Sabashnikov, Anton, MD ; Mohite, Prashant N., MRCS, MCh ; Garcia, Diana, MD ; Weymann, Alexander, MD ; Zych, Bartlomiej, MD ; Bowles, Christopher T., PhD ; Hards, Rachel, RGN ; Hedger, Michael, RGN ; Popov, Aron F., MD ; De Robertis, Fabio, MD ; Moza, Ajay, MD ; Bahrami, Toufan, MD ; Amrani, Mohamed, MD, PhD ; Rahman-Haley, Shelley, MD ; Banner, Nicholas R., FRCP, FESC ; Simon, André Rüdiger, MD, PhD</creator><creatorcontrib>Patil, Nikhil Prakash, MRCS, MCh ; Sabashnikov, Anton, MD ; Mohite, Prashant N., MRCS, MCh ; Garcia, Diana, MD ; Weymann, Alexander, MD ; Zych, Bartlomiej, MD ; Bowles, Christopher T., PhD ; Hards, Rachel, RGN ; Hedger, Michael, RGN ; Popov, Aron F., MD ; De Robertis, Fabio, MD ; Moza, Ajay, MD ; Bahrami, Toufan, MD ; Amrani, Mohamed, MD, PhD ; Rahman-Haley, Shelley, MD ; Banner, Nicholas R., FRCP, FESC ; Simon, André Rüdiger, MD, PhD</creatorcontrib><description>Background Significant aortic regurgitation (AR) after continuous-flow left ventricular assist device (cf-LVAD) placement affects device performance and patient outcomes. This study examined the development of AR and long-term results after implantation of cf-LVADs. Methods The study included all patients with no or less than mild AR who underwent HeartMate II (58 [62%]; Thoratec Corp, Pleasanton, CA) or HeartWare (35 [38%]; HeartWare International, Framingham, MA) implantation at our institute from July 2006 to July 2012. Serial echocardiograms were obtained preoperatively, at 1, 3 and 6 months postoperatively, and then at a minimum of 4-month intervals in patients with longer-term support. Kaplan-Meier estimates for freedom from moderate or greater AR were generated. Logistic regression analysis was used to define independent predictors of AR after cf-LVAD implantation. Results Median duration of LVAD support was 527 days (25th , 75th : 289, 907; range, 60 to 2,433 days). Mild AR developed in 48 patients (51.6%) over a median duration of 126 days, with progression to moderate AR in 13 (14%) over 493 days and to severe AR in 2 (2.1%) over 1,231 days. The incidence of mild or greater AR was 43.1% in HeartMate II vs 65.7% in HeartWare recipients ( p = 0.035). Overall freedom from moderate or greater AR was 94.7% ± 2.6% at 1 year, 86.9% ± 4.5% at 2 years, 82.8% ± 5.9% at 3 years, and 31% ± 16.9% at 4 years. Independent predictors of AR were duration of support (odds ratio, 1.002; 95% confidence interval, 1.000 to 1.004; p = 0.017) and a persistently closed aortic valve (odds ratio, 0.193; 95% confidence interval, 0.097 to 0.382; p < 0.001). Conclusions AR is associated with longer cf-LVAD support duration and persistent aortic valve closure. Incidence of moderate or greater AR after cf-LVAD implantation increases significantly after 3 years. The clinical implications of these data may warrant consideration of prophylactic aortic valve replacement at the time of cf-LVAD implantation, particularly with expected longer duration of support and in patients with preexisting AR that is more than mild.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/j.athoracsur.2014.05.030</identifier><identifier>PMID: 25069685</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Adult ; Aortic Valve Insufficiency - etiology ; Cardiothoracic Surgery ; Female ; Heart-Assist Devices - adverse effects ; Humans ; Male ; Middle Aged ; Prosthesis Implantation - adverse effects ; Retrospective Studies ; Surgery ; Time Factors</subject><ispartof>The Annals of thoracic surgery, 2014-09, Vol.98 (3), p.850-857</ispartof><rights>The Society of Thoracic Surgeons</rights><rights>2014 The Society of Thoracic Surgeons</rights><rights>Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c528t-fde68484c19c1720dd719f6c094deea6366f111447cb54339d7eb11c2c292f823</citedby><cites>FETCH-LOGICAL-c528t-fde68484c19c1720dd719f6c094deea6366f111447cb54339d7eb11c2c292f823</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25069685$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patil, Nikhil Prakash, MRCS, MCh</creatorcontrib><creatorcontrib>Sabashnikov, Anton, MD</creatorcontrib><creatorcontrib>Mohite, Prashant N., MRCS, MCh</creatorcontrib><creatorcontrib>Garcia, Diana, MD</creatorcontrib><creatorcontrib>Weymann, Alexander, MD</creatorcontrib><creatorcontrib>Zych, Bartlomiej, MD</creatorcontrib><creatorcontrib>Bowles, Christopher T., PhD</creatorcontrib><creatorcontrib>Hards, Rachel, RGN</creatorcontrib><creatorcontrib>Hedger, Michael, RGN</creatorcontrib><creatorcontrib>Popov, Aron F., MD</creatorcontrib><creatorcontrib>De Robertis, Fabio, MD</creatorcontrib><creatorcontrib>Moza, Ajay, MD</creatorcontrib><creatorcontrib>Bahrami, Toufan, MD</creatorcontrib><creatorcontrib>Amrani, Mohamed, MD, PhD</creatorcontrib><creatorcontrib>Rahman-Haley, Shelley, MD</creatorcontrib><creatorcontrib>Banner, Nicholas R., FRCP, FESC</creatorcontrib><creatorcontrib>Simon, André Rüdiger, MD, PhD</creatorcontrib><title>De Novo Aortic Regurgitation After Continuous-Flow Left Ventricular Assist Device Implantation</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>Background Significant aortic regurgitation (AR) after continuous-flow left ventricular assist device (cf-LVAD) placement affects device performance and patient outcomes. This study examined the development of AR and long-term results after implantation of cf-LVADs. Methods The study included all patients with no or less than mild AR who underwent HeartMate II (58 [62%]; Thoratec Corp, Pleasanton, CA) or HeartWare (35 [38%]; HeartWare International, Framingham, MA) implantation at our institute from July 2006 to July 2012. Serial echocardiograms were obtained preoperatively, at 1, 3 and 6 months postoperatively, and then at a minimum of 4-month intervals in patients with longer-term support. Kaplan-Meier estimates for freedom from moderate or greater AR were generated. Logistic regression analysis was used to define independent predictors of AR after cf-LVAD implantation. Results Median duration of LVAD support was 527 days (25th , 75th : 289, 907; range, 60 to 2,433 days). Mild AR developed in 48 patients (51.6%) over a median duration of 126 days, with progression to moderate AR in 13 (14%) over 493 days and to severe AR in 2 (2.1%) over 1,231 days. The incidence of mild or greater AR was 43.1% in HeartMate II vs 65.7% in HeartWare recipients ( p = 0.035). Overall freedom from moderate or greater AR was 94.7% ± 2.6% at 1 year, 86.9% ± 4.5% at 2 years, 82.8% ± 5.9% at 3 years, and 31% ± 16.9% at 4 years. Independent predictors of AR were duration of support (odds ratio, 1.002; 95% confidence interval, 1.000 to 1.004; p = 0.017) and a persistently closed aortic valve (odds ratio, 0.193; 95% confidence interval, 0.097 to 0.382; p < 0.001). Conclusions AR is associated with longer cf-LVAD support duration and persistent aortic valve closure. Incidence of moderate or greater AR after cf-LVAD implantation increases significantly after 3 years. The clinical implications of these data may warrant consideration of prophylactic aortic valve replacement at the time of cf-LVAD implantation, particularly with expected longer duration of support and in patients with preexisting AR that is more than mild.</description><subject>Adult</subject><subject>Aortic Valve Insufficiency - etiology</subject><subject>Cardiothoracic Surgery</subject><subject>Female</subject><subject>Heart-Assist Devices - adverse effects</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prosthesis Implantation - adverse effects</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Time Factors</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkc9u1DAQxi0EotvCKyAfuSQdO7aTXJCWLS2VVlTi39XyOpPiJRsvtrOob8Oz9MnqaAtInDiNRvPNNzO_IYQyKBkwdb4tTfrmg7FxCiUHJkqQJVTwhCyYlLxQXLZPyQIAqkK0tTwhpzFuc8pz-Tk54RJUqxq5IPoC6Qd_8HTpQ3KWfsTbKdy6ZJLzI132CQNd-TG5cfJTLC4H_5OusU_0K44pODsNJtBljC4meoEHZ_H-1_VuP5jxaPGCPOvNEPHlYzwjXy7ffV69L9Y3V9er5bqwkjep6DtUjWiEZa1lNYeuq1nbKwut6BCNqpTqGWNC1HYjRVW1XY0bxiy3vOV9w6sz8vrouw_-x4Qx6Z2LFoe8CObFNZMKZN0KmKXNUWqDjzFgr_fB7Uy40wz0jFdv9V-8esarQeqMN7e-epwybXbY_Wn8zTML3h4FmG89OAw6Woejxc4FtEl33v3PlDf_mNjBjc6a4TveYdz6KYyZpWY6cg360_zm-ctMAIOGQ_UASkmnIA</recordid><startdate>20140901</startdate><enddate>20140901</enddate><creator>Patil, Nikhil Prakash, MRCS, MCh</creator><creator>Sabashnikov, Anton, MD</creator><creator>Mohite, Prashant N., MRCS, MCh</creator><creator>Garcia, Diana, MD</creator><creator>Weymann, Alexander, MD</creator><creator>Zych, Bartlomiej, MD</creator><creator>Bowles, Christopher T., PhD</creator><creator>Hards, Rachel, RGN</creator><creator>Hedger, Michael, RGN</creator><creator>Popov, Aron F., MD</creator><creator>De Robertis, Fabio, MD</creator><creator>Moza, Ajay, MD</creator><creator>Bahrami, Toufan, MD</creator><creator>Amrani, Mohamed, MD, PhD</creator><creator>Rahman-Haley, Shelley, MD</creator><creator>Banner, Nicholas R., FRCP, FESC</creator><creator>Simon, André Rüdiger, MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140901</creationdate><title>De Novo Aortic Regurgitation After Continuous-Flow Left Ventricular Assist Device Implantation</title><author>Patil, Nikhil Prakash, MRCS, MCh ; Sabashnikov, Anton, MD ; Mohite, Prashant N., MRCS, MCh ; Garcia, Diana, MD ; Weymann, Alexander, MD ; Zych, Bartlomiej, MD ; Bowles, Christopher T., PhD ; Hards, Rachel, RGN ; Hedger, Michael, RGN ; Popov, Aron F., MD ; De Robertis, Fabio, MD ; Moza, Ajay, MD ; Bahrami, Toufan, MD ; Amrani, Mohamed, MD, PhD ; Rahman-Haley, Shelley, MD ; Banner, Nicholas R., FRCP, FESC ; Simon, André Rüdiger, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c528t-fde68484c19c1720dd719f6c094deea6366f111447cb54339d7eb11c2c292f823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aortic Valve Insufficiency - etiology</topic><topic>Cardiothoracic Surgery</topic><topic>Female</topic><topic>Heart-Assist Devices - adverse effects</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prosthesis Implantation - adverse effects</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patil, Nikhil Prakash, MRCS, MCh</creatorcontrib><creatorcontrib>Sabashnikov, Anton, MD</creatorcontrib><creatorcontrib>Mohite, Prashant N., MRCS, MCh</creatorcontrib><creatorcontrib>Garcia, Diana, MD</creatorcontrib><creatorcontrib>Weymann, Alexander, MD</creatorcontrib><creatorcontrib>Zych, Bartlomiej, MD</creatorcontrib><creatorcontrib>Bowles, Christopher T., PhD</creatorcontrib><creatorcontrib>Hards, Rachel, RGN</creatorcontrib><creatorcontrib>Hedger, Michael, RGN</creatorcontrib><creatorcontrib>Popov, Aron F., MD</creatorcontrib><creatorcontrib>De Robertis, Fabio, MD</creatorcontrib><creatorcontrib>Moza, Ajay, MD</creatorcontrib><creatorcontrib>Bahrami, Toufan, MD</creatorcontrib><creatorcontrib>Amrani, Mohamed, MD, PhD</creatorcontrib><creatorcontrib>Rahman-Haley, Shelley, MD</creatorcontrib><creatorcontrib>Banner, Nicholas R., FRCP, FESC</creatorcontrib><creatorcontrib>Simon, André Rüdiger, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patil, Nikhil Prakash, MRCS, MCh</au><au>Sabashnikov, Anton, MD</au><au>Mohite, Prashant N., MRCS, MCh</au><au>Garcia, Diana, MD</au><au>Weymann, Alexander, MD</au><au>Zych, Bartlomiej, MD</au><au>Bowles, Christopher T., PhD</au><au>Hards, Rachel, RGN</au><au>Hedger, Michael, RGN</au><au>Popov, Aron F., MD</au><au>De Robertis, Fabio, MD</au><au>Moza, Ajay, MD</au><au>Bahrami, Toufan, MD</au><au>Amrani, Mohamed, MD, PhD</au><au>Rahman-Haley, Shelley, MD</au><au>Banner, Nicholas R., FRCP, FESC</au><au>Simon, André Rüdiger, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>De Novo Aortic Regurgitation After Continuous-Flow Left Ventricular Assist Device Implantation</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>2014-09-01</date><risdate>2014</risdate><volume>98</volume><issue>3</issue><spage>850</spage><epage>857</epage><pages>850-857</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><abstract>Background Significant aortic regurgitation (AR) after continuous-flow left ventricular assist device (cf-LVAD) placement affects device performance and patient outcomes. This study examined the development of AR and long-term results after implantation of cf-LVADs. Methods The study included all patients with no or less than mild AR who underwent HeartMate II (58 [62%]; Thoratec Corp, Pleasanton, CA) or HeartWare (35 [38%]; HeartWare International, Framingham, MA) implantation at our institute from July 2006 to July 2012. Serial echocardiograms were obtained preoperatively, at 1, 3 and 6 months postoperatively, and then at a minimum of 4-month intervals in patients with longer-term support. Kaplan-Meier estimates for freedom from moderate or greater AR were generated. Logistic regression analysis was used to define independent predictors of AR after cf-LVAD implantation. Results Median duration of LVAD support was 527 days (25th , 75th : 289, 907; range, 60 to 2,433 days). Mild AR developed in 48 patients (51.6%) over a median duration of 126 days, with progression to moderate AR in 13 (14%) over 493 days and to severe AR in 2 (2.1%) over 1,231 days. The incidence of mild or greater AR was 43.1% in HeartMate II vs 65.7% in HeartWare recipients ( p = 0.035). Overall freedom from moderate or greater AR was 94.7% ± 2.6% at 1 year, 86.9% ± 4.5% at 2 years, 82.8% ± 5.9% at 3 years, and 31% ± 16.9% at 4 years. Independent predictors of AR were duration of support (odds ratio, 1.002; 95% confidence interval, 1.000 to 1.004; p = 0.017) and a persistently closed aortic valve (odds ratio, 0.193; 95% confidence interval, 0.097 to 0.382; p < 0.001). Conclusions AR is associated with longer cf-LVAD support duration and persistent aortic valve closure. Incidence of moderate or greater AR after cf-LVAD implantation increases significantly after 3 years. The clinical implications of these data may warrant consideration of prophylactic aortic valve replacement at the time of cf-LVAD implantation, particularly with expected longer duration of support and in patients with preexisting AR that is more than mild.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>25069685</pmid><doi>10.1016/j.athoracsur.2014.05.030</doi><tpages>8</tpages></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Aortic Valve Insufficiency - etiology Cardiothoracic Surgery Female Heart-Assist Devices - adverse effects Humans Male Middle Aged Prosthesis Implantation - adverse effects Retrospective Studies Surgery Time Factors |
| title | De Novo Aortic Regurgitation After Continuous-Flow Left Ventricular Assist Device Implantation |
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