Predictors of survival following trans‐catheter aortic valve closure for left ventricular assist device associated aortic insufficiency. Issue 5 (3rd November 2015)

• Record Type: Journal Article
• Authors: Retzer, Elizabeth M.; Sayer, Gabriel T.; Fedson, Savitri E.; Nathan, Sandeep; Jeevanandam, Valluvan; Friant, Janet; Uriel, Nir; Lang, Roberto M.; Russo, Mark J.; Shah, Atman P.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 87:Issue 5(2016)
• Page Start: 971
• Page End: 979
• Publication Date: 2015-11-03
• Subjects: aortic valve insufficiency -- heart failure -- ventricular assist device; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.26280
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract : Objective: This study sought to assess the long‐term clinical benefits and predictors of survival of trans‐catheter aortic valve closure in left ventricular assist device (LVAD) patients. Background: LVADs have been shown to increase survival and quality of life in patients with end‐stage heart failure. However, severe aortic insufficiency (AI) can develop in up to 50% of patients at 12 months resulting in significant morbidity and mortality. Trans‐catheter treatment of LVAD associated AI has emerged as a potential alternative to surgical treatment. Methods: We conducted a retrospective analysis of all patients undergoing trans‐catheter aortic valve closure using an Amplatzer Multi‐Fenestrated Septal Occluder "Cribriform" device to assess potential clinical and procedural factors associated with survival. Student's t ‐tests were used to compare baseline patient demographics and procedural characteristics, as well as patient outcomes immediately post procedure and at 6 months. A P ‐value of less than 0.05 was considered statistically significant. Results: A total of 10 patients (70% male, median age 59 years) were included. Technical success was accomplished in 100% of patients with a 6 month survival rate of 30% (3/10). Compared with survivors, non‐survivors had a higher rate of pre‐procedural clinical co‐morbidities, an increased likelihood of right ventricular failure, and received larger occluder devices. Conclusions: Trans‐catheter aortic valve closure successfully treats late severe AI in LVAD patients, however, the presence or development of right heart failure portends a worse prognosis. Further studies are needed to investigate the factors involved in the development of right ventricular failure, and potential treatment, in patients undergoing trans‐catheter aortic valve closure. © 2015 Wiley Periodicals, Inc.