Surgical correction of aortic valve insufficiency after left ventricular assist device implantation.
J Thorac Cardiovasc Surg
; 146(5): 1247-52, 2013 Nov.
Article
en En
| MEDLINE
| ID: mdl-23870154
OBJECTIVES: New-onset aortic insufficiency (AI) can be encountered after instituting mechanical circulatory support and seems more common and severe with continuous flow (CF) left ventricular assist devices (LVADs) compared with pulsatile devices. Treatment algorithms for de novo, post-LVAD AI have not been well defined. In the present report, we have described 6 patients who underwent aortic valve surgery for new-onset post-LVAD AI. METHODS: From 2005 to 2011, 271 patients underwent LVAD implantation. Of these LVADs, 225 were CF devices (203 HeartMate II devices, Thoratec Corp, Pleasanton, Calif; and 22 HVAD devices, HeartWare Intl, Inc, Framingham, Mass). The patients were examined for new-onset severe AI requiring surgical intervention. RESULTS: During follow-up, 6 CF LVAD patients developed new, severe AI that was accompanied by heart failure. After medical therapy had failed, 4 patients underwent redo sternotomy for aortic valve procedures (1 bioprosthetic valve replacement, 1 Dacron patch closure, and 2 aortic valve repairs), and 2 patients underwent transcatheter aortic valve procedure, with 1 requiring revision by open surgery for aortic valve replacement. Of the 6 patients, 5 experienced significant improvement in functional capacity and symptoms. One patient died postoperatively secondary to multiorgan failure and sepsis. CONCLUSIONS: Surgical treatment of post-LVAD AI with aortic valve oversewing or leaflet repair or by bioprosthetic aortic valve replacement is effective at restoring functional capacity for CF LVAD patients who develop symptomatic, severe AI and can be performed safely with good results. Various transcatheter approaches to these difficult problems are also available and offer less invasive alternatives to conventional surgery.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Insuficiencia de la Válvula Aórtica
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Cateterismo Cardíaco
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Corazón Auxiliar
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Función Ventricular Izquierda
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Técnicas de Sutura
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Implantación de Prótesis de Válvulas Cardíacas
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Insuficiencia Cardíaca
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
Límite:
Adult
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Aged
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Female
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Humans
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Male
Idioma:
En
Revista:
J Thorac Cardiovasc Surg
Año:
2013
Tipo del documento:
Article
Pais de publicación:
Estados Unidos