Long-Term Continuous-Flow Left Ventricular Assist Device Support After Left Ventricular Outflow Tract Closure

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Devices

Background:

• Aortic valve insufficiency is a common complication during continuous-flow left ventricular assist device (CF-LVAD) implantation.
• Management options include aortic valve repair/replacement or left ventricular outflow tract (LVOT) closure.
• Long-term safety data for LVOT closure during CF-LVAD implantation are limited.

Purpose of the Study:

• To evaluate the safety and long-term outcomes of CF-LVAD implantation with concomitant LVOT closure in patients with severe aortic insufficiency.
• To compare outcomes with CF-LVAD implantation without LVOT closure.

Main Methods:

• Retrospective analysis of 16 patients undergoing CF-LVAD implantation with LVOT closure (2003-2016).
• Comparison with 510 CF-LVAD recipients without LVOT closure.
• Analysis of survival and neurologic dysfunction rates.

Main Results:

• Survival rates at 30 days, 6 months, 1 year, and 2 years were comparable between the LVOT closure group (81.3%, 81.3%, 75.0%, 68.8%) and the CF-LVAD-only group (90.4%, 80.6%, 74.3%, 67.5%).
• No deaths were attributed to LVOT closure.
• Event rates for neurologic dysfunction per patient-year were similar (0.23 in LVOT closure group vs. 0.20 in CF-LVAD-only group).

Conclusions:

• Left ventricular outflow tract (LVOT) closure is a viable and safe option for select patients with aortic insufficiency undergoing continuous-flow left ventricular assist device (CF-LVAD) implantation.
• This approach yields acceptable long-term outcomes, comparable to standard CF-LVAD procedures.