Aortic insufficiency in patients with sustained left ventricular systolic dysfunction after axial flow assist device implantation

Teruhiko Imamura, Koichiro Kinugawa, Takeo Fujino, Toshiro Inaba, Hisataka Maki, Masaru Hatano, Osamu Kinoshita, Kan Nawata, Shunei Kyo, Minoru Ono

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Predicting the occurrence of aortic insufficiency (AI) during left ventricular assist device (LVAD) support has remained unsolved.

Methods and Results: We enrolled 52 patients who had received continuous flow LVAD (14 axial and 38 centrifugal pumps) and who been followed for >6 months between Jun 2006 and Dec 2013. Native aortic valve (AV) opening was observed in 18 patients (35%) with improved LV systolic function, and none of them had AI. On multivariate logistic regression analysis preoperative shorter heart failure duration was the only independent predictor of postoperative native AV opening (P=0.042; odds ratio [OR], 0.999). Of the remaining 34 patients (65%) with closed AV, 11 had AI with enlargement of the aortic root and narrow pulse pressure. Among those with closed AV, axial pump use (n=13) was the only significant predictor of the development of AI (P=0.042; OR, 4.950). Patients with AI had lower exercise capacity and a higher readmission rate than those without AI during 2-year LVAD support (55% vs. 8%; P<0.001).

Conclusions: Native AV opening during LVAD support is profoundly associated with reversal of LV systolic function, especially in patients with preoperative shorter heart failure duration. Among those in whom the native AV remains closed, low pulsatility of axial flow pump may facilitate aortic root remodeling and post-LVAD AI development that results in worse clinical outcome. (Circ J 2015; 79: 104-111)

Original languageEnglish
Pages (from-to)23-41
Number of pages19
JournalCirculation Journal
Volume79
Issue number1
DOIs
Publication statusPublished - Dec 19 2014

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Left Ventricular Dysfunction
Heart-Assist Devices
Aortic Valve
Equipment and Supplies
Heart Failure
Odds Ratio
Logistic Models
Regression Analysis
Exercise
Blood Pressure

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Aortic insufficiency in patients with sustained left ventricular systolic dysfunction after axial flow assist device implantation. / Imamura, Teruhiko; Kinugawa, Koichiro; Fujino, Takeo; Inaba, Toshiro; Maki, Hisataka; Hatano, Masaru; Kinoshita, Osamu; Nawata, Kan; Kyo, Shunei; Ono, Minoru.

In: Circulation Journal, Vol. 79, No. 1, 19.12.2014, p. 23-41.

Research output: Contribution to journalArticle

Imamura, T, Kinugawa, K, Fujino, T, Inaba, T, Maki, H, Hatano, M, Kinoshita, O, Nawata, K, Kyo, S & Ono, M 2014, 'Aortic insufficiency in patients with sustained left ventricular systolic dysfunction after axial flow assist device implantation', Circulation Journal, vol. 79, no. 1, pp. 23-41. https://doi.org/10.1253/circj.CJ-14-0944
Imamura, Teruhiko ; Kinugawa, Koichiro ; Fujino, Takeo ; Inaba, Toshiro ; Maki, Hisataka ; Hatano, Masaru ; Kinoshita, Osamu ; Nawata, Kan ; Kyo, Shunei ; Ono, Minoru. / Aortic insufficiency in patients with sustained left ventricular systolic dysfunction after axial flow assist device implantation. In: Circulation Journal. 2014 ; Vol. 79, No. 1. pp. 23-41.
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abstract = "Background: Predicting the occurrence of aortic insufficiency (AI) during left ventricular assist device (LVAD) support has remained unsolved.Methods and Results: We enrolled 52 patients who had received continuous flow LVAD (14 axial and 38 centrifugal pumps) and who been followed for >6 months between Jun 2006 and Dec 2013. Native aortic valve (AV) opening was observed in 18 patients (35{\%}) with improved LV systolic function, and none of them had AI. On multivariate logistic regression analysis preoperative shorter heart failure duration was the only independent predictor of postoperative native AV opening (P=0.042; odds ratio [OR], 0.999). Of the remaining 34 patients (65{\%}) with closed AV, 11 had AI with enlargement of the aortic root and narrow pulse pressure. Among those with closed AV, axial pump use (n=13) was the only significant predictor of the development of AI (P=0.042; OR, 4.950). Patients with AI had lower exercise capacity and a higher readmission rate than those without AI during 2-year LVAD support (55{\%} vs. 8{\%}; P<0.001).Conclusions: Native AV opening during LVAD support is profoundly associated with reversal of LV systolic function, especially in patients with preoperative shorter heart failure duration. Among those in whom the native AV remains closed, low pulsatility of axial flow pump may facilitate aortic root remodeling and post-LVAD AI development that results in worse clinical outcome. (Circ J 2015; 79: 104-111)",
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AU - Fujino, Takeo

AU - Inaba, Toshiro

AU - Maki, Hisataka

AU - Hatano, Masaru

AU - Kinoshita, Osamu

AU - Nawata, Kan

AU - Kyo, Shunei

AU - Ono, Minoru

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N2 - Background: Predicting the occurrence of aortic insufficiency (AI) during left ventricular assist device (LVAD) support has remained unsolved.Methods and Results: We enrolled 52 patients who had received continuous flow LVAD (14 axial and 38 centrifugal pumps) and who been followed for >6 months between Jun 2006 and Dec 2013. Native aortic valve (AV) opening was observed in 18 patients (35%) with improved LV systolic function, and none of them had AI. On multivariate logistic regression analysis preoperative shorter heart failure duration was the only independent predictor of postoperative native AV opening (P=0.042; odds ratio [OR], 0.999). Of the remaining 34 patients (65%) with closed AV, 11 had AI with enlargement of the aortic root and narrow pulse pressure. Among those with closed AV, axial pump use (n=13) was the only significant predictor of the development of AI (P=0.042; OR, 4.950). Patients with AI had lower exercise capacity and a higher readmission rate than those without AI during 2-year LVAD support (55% vs. 8%; P<0.001).Conclusions: Native AV opening during LVAD support is profoundly associated with reversal of LV systolic function, especially in patients with preoperative shorter heart failure duration. Among those in whom the native AV remains closed, low pulsatility of axial flow pump may facilitate aortic root remodeling and post-LVAD AI development that results in worse clinical outcome. (Circ J 2015; 79: 104-111)

AB - Background: Predicting the occurrence of aortic insufficiency (AI) during left ventricular assist device (LVAD) support has remained unsolved.Methods and Results: We enrolled 52 patients who had received continuous flow LVAD (14 axial and 38 centrifugal pumps) and who been followed for >6 months between Jun 2006 and Dec 2013. Native aortic valve (AV) opening was observed in 18 patients (35%) with improved LV systolic function, and none of them had AI. On multivariate logistic regression analysis preoperative shorter heart failure duration was the only independent predictor of postoperative native AV opening (P=0.042; odds ratio [OR], 0.999). Of the remaining 34 patients (65%) with closed AV, 11 had AI with enlargement of the aortic root and narrow pulse pressure. Among those with closed AV, axial pump use (n=13) was the only significant predictor of the development of AI (P=0.042; OR, 4.950). Patients with AI had lower exercise capacity and a higher readmission rate than those without AI during 2-year LVAD support (55% vs. 8%; P<0.001).Conclusions: Native AV opening during LVAD support is profoundly associated with reversal of LV systolic function, especially in patients with preoperative shorter heart failure duration. Among those in whom the native AV remains closed, low pulsatility of axial flow pump may facilitate aortic root remodeling and post-LVAD AI development that results in worse clinical outcome. (Circ J 2015; 79: 104-111)

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