Management of prosthetic valves during ventricular assist device implantation

An increasing number of patients requiring ventricular assist devices (VAD) have had previous valvular corrections, including valve repair and valve replacement with mechanical or bioprosthetic valves. The operative and peri-operative management of these patients has been varied.

A retrospective study of VADs between January 1994 and June 2008 revealed 10 patients with previous prosthetic valves requiring management during and after VAD placement. Three patients were supported postcardiotomy after valve surgery. Two patients were supported due to cardiogenic shock postoperatively. Four patients were supported as a bridge to transplantation. One patient was supported as a destination therapy (DT).

The mitral, valve was left untreated during VAD implantation regardless of valve repair or replacement. For aortic valves, the mechanical aortic valve was replaced with tissue valve in two patients and left untreated in one case. One patient had tricuspid valve repair previously and was left untouched. All patients with prosthetic valves in aortic, mitral and tricuspid position during VAD support received anticoagulation therapy. There were four deaths, and four went on to transplantation. One patient was weaned from VAD and discharged from the hospital. One patient received HeartMate I as DT. The most common causes of death were multisystem organ failure (MSOF) and sepsis. One patient had a thromboembolic event.

The survival rate of 60% is encouraging when compared to overall survival rates. The most common cause of death was MSOF. Patients with prosthetic valves may be safely managed during VAD support.