Aortic insufficiency in continuous-flow left ventricular assist device support patients is common but does not impact long-term mortality

Background Aortic insufficiency (AI) is a significant long-term complication of continuous-flow left ventricular assist device (CF-LVAD) implantation. We sought to evaluate its impact on clinical outcomes and mortality in CF-LVAD recipients. Methods We retrospectively analyzed 237 patients implanted with HeartMate II CF-LVADs at our institution from June 2005 through June 2013. We evaluated recipients’ baseline characteristics and annual echocardiograms, grading AI severity as: none, trace, mild, moderate or severe. Only moderate or severe AI were considered to be clinically significant. Recipients who underwent concomitant aortic valve surgery or who had undergone prior prosthetic aortic valve implantation were excluded. Results Moderate or severe AI occurred in 32 (15.2%) patients. Risk factors that significantly affected the development of AI included older age at the time of implantation, female gender, longer duration of LVAD support, and destination therapy designation. Freedom from moderate or severe AI was 94%, 76%, and 65% at 1, 3, and 5 years respectively. Overall cohort survival based on Kaplan-Meier analysis was 78%, 59% and 42% at 1, 3, and 5 years, respectively. There was no difference in survival between recipients who developed significant AI and those that did not (log-rank, P=0.73). Conclusions In this large single-institution study, the overall rate of AI was low, but increased in frequency with longer duration of LVAD support. Although AI development remains a concern for patients on long-term CF-LVAD support, AI development does not appear to impact long-term mortality.