Simultaneous aortic valve replacement in left ventricular assist device recipients: single-center experience

Area of Science:

• Cardiovascular Surgery
• Medical Devices
• Heart Failure Management

Background:

• Aortic valve disease (regurgitation or mechanical prosthesis) is a contraindication for left ventricular assist device (LVAD) implantation.
• Aortic valve replacement (AVR) with a biological prosthesis is a viable option in such cases.
• This study evaluates the outcomes of concomitant AVR and LVAD implantation.

Purpose of the Study:

• To assess the safety and efficacy of simultaneous aortic valve replacement and LVAD implantation.
• To compare outcomes between patients undergoing combined procedures and those receiving LVAD alone.
• To analyze outcomes based on INTERMACS profiles.

Main Methods:

• Retrospective analysis of 318 LVAD recipients between January 2008 and January 2012.
• 19 patients underwent simultaneous aortic valve replacement (AVR) and LVAD implantation.
• Patients were stratified into INTERMACS (IM) levels (Group 1: IM 1-2, Group 2: IM 3-4) and compared to control groups (Group 3: IM 1-2, Group 4: IM 3-5) of LVAD-only recipients.

Main Results:

• Concomitant AVR and LVAD implantation led to longer cardiopulmonary bypass times.
• Patients with lower INTERMACS levels undergoing combined procedures showed trends towards higher rates of right ventricular failure and significantly worse outcomes (longer ICU stay, ventilation, and in-hospital mortality).
• Patients with higher INTERMACS levels undergoing combined procedures had similar outcomes to controls.

Conclusions:

• Simultaneous AVR and LVAD implantation does not negatively impact outcomes in stable patients (lower INTERMACS levels).
• In patients with cardiogenic shock (higher INTERMACS levels), combined AVR and LVAD may be associated with poorer outcomes.
• Alternative surgical strategies should be considered for patients with cardiogenic shock requiring both LVAD and AVR.