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Imamura T, Narang N, Kim G, Nitta D, Fujino T, Nguyen A, Grinstein J, Rodgers D, Ota T, Raikhelkar J, Jeevanandam V, Sayer G, Uriel N. Impact of worsening of aortic insufficiency during HeartMate 3 LVAD support. Artif Organs 2020; 45:297-302. [PMID: 33098153 DOI: 10.1111/aor.13825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
Aortic insufficiency remains a difficult to treat and highly morbid condition even in the era of HeartMate 3 left ventricular assist devices (LVADs). The prognostic nature of the longitudinal progression of aortic insufficiency, however, remains unknown. We prospectively collected data on patients who received HeartMate 3 LVAD implantation, who had assessments of aortic insufficiency using a novel Doppler echocardiography obtained at outflow graft at three (baseline) and 6 months postimplant. Patients with moderate or greater aortic insufficiency at baseline were excluded. The risk of aortic insufficiency progression on 1-year death and readmission for heart failure was investigated. In total, 41 patients (median 51 years old and 29 males) were included. All patients had less than moderate aortic insufficiency at baseline. Of them, 22 patients had worsening aortic insufficiency for 3 months following baseline assessments, which was associated with a significantly higher risk of 1-year death or heart failure readmission rate (41% vs. 11%, P = .023) with a hazard ratio of 3.24 (95% confidence interval 1.02-18.5, P = .038) adjusted for device speed at baseline and destination therapy indication. In patients with HeartMate 3 LVADs, progressive aortic insufficiency may be associated with a higher risk of 1-year death or readmission for heart failure. Close monitoring of patients with baseline aortic insufficiency should be considered as a measure to risk-stratify those for future adverse events.
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Affiliation(s)
- Teruhiko Imamura
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.,Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Nikhil Narang
- Division of Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Gene Kim
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Daisuke Nitta
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Takeo Fujino
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Ann Nguyen
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Jonathan Grinstein
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Daniel Rodgers
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Takeyoshi Ota
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Jayant Raikhelkar
- Cardiology Division, Columbia University Medical Center, New York, NY, USA
| | | | - Gabriel Sayer
- Cardiology Division, Columbia University Medical Center, New York, NY, USA
| | - Nir Uriel
- Cardiology Division, Columbia University Medical Center, New York, NY, USA
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