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Published on: July 18, 2014
Partial aortic valve fusion induced by left ventricular assist device
1Department of Laboratory Medicine and Pathology, University of Minnesota and Fairview-University Medical Center, Minneapolis, USA. rosex031@tc.umn.edu
The Annals of Thoracic Surgery
|November 18, 2000
Summary
Left ventricular assist devices (LVADs) can cause acquired aortic stenosis due to permanent aortic valve closure and thrombus formation. This complication may impact patients awaiting recovery or device failure, necessitating preventative strategies.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Pathology
Background:
- Left ventricular assist devices (LVADs) are used for cardiac transplantation, permanent support, or bridge to recovery.
- For patients bridging to recovery, LVADs must not negatively impact future cardiac function.
- LVAD failure necessitates optimal native heart function for survival.
Purpose of the Study:
- To investigate valvular heart disease in patients with LVADs.
- To assess the incidence and nature of commissural fusion in explanted hearts with LVADs.
- To identify potential complications of LVAD use on native heart valves.
Main Methods:
- Examination of explanted hearts (transplant or autopsy) with LVADs.
- Assessment for native valvular heart disease, specifically commissural fusion.
- Histopathological analysis of valve lesions using light microscopy.
Main Results:
- Four of six patients with HeartMate LVADs exhibited commissural fusion, indicative of acquired aortic stenosis.
- Thrombus organization was the primary cause of fusion, affecting aortic valve commissures.
- Mean commissural fusion length was 5.4 mm, with LVAD implantation durations ranging from 26 to 689 days.
Conclusions:
- LVADs operating normally can lead to permanent aortic valve closure and subsequent aortic stenosis.
- Thrombosis and organization of thrombi on the aortic valve are favored by stasis and anticoagulation.
- This complication, undetected clinically, has serious implications for patient recovery and device failure, suggesting prevention through modified LVAD function.
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