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Practical valvular issues in patients requiring ventricular assist devices.

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Ventricular assist device (VAD) therapy for advanced heart failure is increasing. This review examines valvular disease management in VAD patients, highlighting ongoing controversies and evolving strategies for aortic, mitral, and tricuspid regurgitation.

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Devices

Background:

  • Ventricular assist device (VAD) therapy is expanding for advanced heart failure.
  • Concomitant valvular disease is common in VAD patients, presenting pre- or post-implantation.

Purpose of the Study:

  • To review current data and practices regarding valvular disease in VAD recipients.
  • To discuss the management of aortic, mitral, and tricuspid regurgitation in this population.

Main Methods:

  • Literature review of recent data and current practices.
  • Analysis of findings related to valvular degeneration, insufficiency, and regurgitation post-VAD.

Main Results:

  • Persistent aortic valve closure may lead to degeneration; aortic root dilation predicts insufficiency.
  • Mitral regurgitation repair may benefit hemodynamics, but tricuspid regurgitation repair shows no clear benefit.
  • Atrial fibrillation is a risk factor for worsening tricuspid regurgitation.

Conclusions:

  • Management of valvular disease in VAD patients remains controversial and is an evolving area.
  • Ongoing research and accumulating experience are crucial for refining treatment strategies.