Transcatheter aortic valve repair for management of aortic insufficiency in patients supported with left ventricular assist devices

2016 ◽  
Vol 31 (10) ◽  
pp. 654-657 ◽  
Author(s):  
Jay D. Pal ◽  
James M. McCabe ◽  
Todd Dardas ◽  
Gabriel S. Aldea ◽  
Nahush A. Mokadam
Keyword(s):  
Aortic Valve ◽  
Aortic Insufficiency ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Aortic Valve Repair ◽  
Left Ventricular Assist Devices ◽  
Valve Repair ◽  
Ventricular Assist ◽  
Transcatheter Aortic Valve ◽  
Left Ventricular Assist

Aortic Valve Repair Versus Replacement Associated With Durable Left Ventricular Assist Devices

2020 ◽  
Vol 110 (4) ◽  
pp. 1259-1264 ◽  
Author(s):  
Paul C. Tang ◽  
Nadeen Sarsour ◽  
Jonathan W. Haft ◽  
Matthew A. Romano ◽  
Matthew Konerman ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Aortic Valve Repair ◽  
Left Ventricular Assist Devices ◽  
Valve Repair ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

Abstract 16373: Improved Prognostic Performance of Novel Parameters for Grading Aortic Insufficiency Severity in Patients With Left Ventricular Assist Devices

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jonathan Grinstein ◽  
Eric Kruse ◽  
Gabriel Sayer ◽  
Savitri Fedson ◽  
Gene H Kim ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Insufficiency ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Cardiac Events ◽  
Ventricular Assist ◽  
Prognostic Performance ◽  
Left Ventricular Assist ◽  
Outflow Cannula

Background: The development of aortic insufficiency (AI) following continuous flow left ventricular assist device (CF-LVAD) implantation is common, although the clinical significance remains unclear. We previously described novel echocardiographic (TTE) parameters that outperformed traditional TTE parameters in grading AI severity in these patients. The aim of this study was to evaluate the prognostic performance of these parameters compared to traditional measurements. Methods: CF-LVAD patients with varying degrees of AI (N=57) underwent Doppler TTE of the LVAD outflow cannula. All patients had AI severity graded by our novel parameters (Systolic/Diastolic ratio and the diastolic acceleration of the LVAD outflow cannula) and traditional vena contracta. The prognostic performance of novel and traditional AI parameters was determined by comparing rates of hospital readmission, need for aortic valve intervention and/or urgent transplantation and death (primary endpoints) for each parameter. Results: Grading AI severity using novel AI parameters led to reclassification of 21% of patients from trace/mild AI to moderate or greater AI (N=12). Using traditional AI parameters, there was no difference in the occurrence of the primary endpoint between the trace/mild group and the moderate or greater group (1.08 vs. 0.89 events/person, p=0.39) (Figure 1A). With the novel AI parameters, there were significantly more events in the patients with moderate or greater AI compared to those with trace/mild. (1.11 vs. 0.56 events/person, p=0.02) (Figure 1B). Novel parameters better predicted the need for aortic valve intervention, urgent transplantation or death than traditional methods (p=0.049) (Figure 1C-D). Conclusions: In patients with CF-LVADs, traditional parameters tend to underestimate AI severity and future cardiac events. Novel AI TTE parameters are better able to discriminate AI severity and predict clinically meaningful outcomes.

Aortic Regurgitation in Patients with Left Ventricular Assist Devices

2019 ◽  
pp. 338-344
Author(s):  
Marisa Cevasco ◽  
Koji Takeda ◽  
Masahiko Ando ◽  
Yoshifumi Naka
Keyword(s):  
Surgical Techniques ◽  
Treatment Strategies ◽  
Aortic Insufficiency ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

Aortic insufficiency (AI) occurs as a complication in 25% to 37% of cases that receive left ventricular assist devices (LVAD). The incidence increases after implant by 1% to 6% per month of continued support. Uncertainty remains over the appropriate management of pump speeds to help delay this deterioration (complete emptying versus allowing native ventricular function open the aortic on a regular basis). Significant AI can lead to hemodynamic impairment with adverse outcomes over time. Due to the recirculation of blood, the calculated cardiac output of the LVAD may be markedly skewed. A number of surgical techniques have been proposed for the prevention and management of AI in the setting of LVAD therapy. This chapter details the causes, treatment strategies, and outcomes associated with this complication.

scholarly journals Stochastic Modeling and Dynamic Analysis of the Cardiovascular System with Rotary Left Ventricular Assist Devices

2019 ◽  
Vol 2019 ◽  
pp. 1-18 ◽  
Author(s):  
Jeongeun Son ◽  
Dongping Du ◽  
Yuncheng Du
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Pump Power ◽  
Aortic Valve ◽  
Cardiovascular System ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Left ventricular assist devices (LVADs) have been used for end-stage heart failure patients as a therapeutic option. The aortic valve plays a critical role in heart failure and its treatment with a LVAD. The cardiovascular-LVAD model is often used to investigate the physiological demands required by patients and predict the hemodynamic of the native heart supported with a LVAD. As it is a “bridge-to-recovery” treatment, it is important to maintain appropriate and active dynamics of the aortic valve and the cardiac output of the native heart, which requires that the LVAD pump be adjusted so that a proper balance between the blood contributed through the aortic valve and the pump is maintained. In this paper, we investigate how the pump power of the LVAD pump can affect the dynamic behaviors of the aortic valve for different levels of activity and different severities of heart failure. Our objective is to identify a critical value of the pump power (i.e., breakpoint) to ensure that the LVAD pump does not take over the pumping function in the cardiovascular-pump system and share the ejected blood with the left ventricle to help the heart to recover. In addition, the hemodynamic often involves variability due to patients’ heterogeneity and the stochastic nature of the cardiovascular system. The variability poses significant challenges to understanding dynamic behaviors of the aortic valve and cardiac output. A generalized polynomial chaos (gPC) expansion is used in this work to develop a stochastic cardiovascular-pump model for efficient uncertainty propagation, from which it is possible to rapidly calculate the variance in the aortic valve opening duration and the cardiac output in the presence of variability. The simulation results show that the gPC-based cardiovascular-pump model is a reliable platform that can provide useful information to understand the effect of the LVAD pump on the hemodynamic of the heart.

Pulse assessment is important with blood pressure measurement in individuals with continuous flow left ventricular assist devices

2020 ◽  
pp. 039139882092702
Author(s):  
Hernan G Marcos-Abdala ◽  
Ana S Cruz-Solbes ◽  
Imad Hussain ◽  
Barry Trachtenberg ◽  
Guha Ashrith ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Valve ◽  
Continuous Flow ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist ◽  
Valve Opening

While Doppler and cuff blood pressure techniques are prevalent methods of assessing blood pressure in patients with continuous flow left ventricular assist devices, the impact of pulsatility on measurement is not well established. Retrospective chart analysis of clinical variables including pulse perception, blood pressure (Doppler and standard cuff), and aortic valve opening on echo at clinic visit were abstracted. Stable outpatients on continuous flow left ventricular assist devices support with concomitant portable echo assessment were included. Mean average difference was calculated and Pearson’s correlation performed for all those patients who had both Doppler and cuff pressure obtained. In all, 74 Heartmate-II patients with a median time from implant of 380 days were analyzed. A pulse was perceived in 82% of patients with persistent aortic valve opening on portable echo and also in 30% of those who had a persistently closed aortic valve. The mean average difference between the Doppler and systolic cuff pressure was ~13 mmHg ( r = 0.5, p = 0.004) when a pulse was present and ~11 mmHg when aortic valve was open ( r = 0.68, p < 0.0001). Pulse presence seems to reflect aortic valve opening a majority of the time but not always. In the presence of a prominent pulse or persistent aortic valve opening, the Doppler pressure seems to be more reflective of a systolic pressure than mean perfusion pressure. Hence, assessment of pulsatility needs to be incorporated into blood pressure measurement methods for patients with continuous flow left ventricular assist devices.

Sign in / Sign up

Export Citation Format

Share Document