Improved survival with concomitant surgery for aortic regurgitation during continuous-flow left ventricular assist...

Despite the detrimental consequences associated with residual, progressive aortic regurgitation (AR) during LVAD support, correction of AR at LVAD implantation has rarely been shown to improve survival.

A retrospective study was conducted using the Japanese registry database, which included 300 continuous-flow LVAD recipients with pre-existing AR (mild or greater). Patients were divided into two groups: those who underwent concomitant surgery for AR during LVAD implantation (n = 77) and those who did not (n = 223). The groups were compared for significant AR development, all-cause mortality, and readmission for adverse events. A propensity score-matched cohort was also created to allow comparison of these outcomes to those of patients with similar baseline.

The cumulative incidence of significant AR was lower after corrected AR than after uncorrected AR in both the pre-matched and matched analyses (p < 0.05). While mortality and readmission rates were similar between groups in the pre-matched cohort, mortality after uncorrected AR was higher in the matched cohort (p = 0.052). When the pre-matched cohort was divided by age, a trend towards improved survival (p = 0.099) was observed with correction compared to no correction in older patients (≥57 years), whereas the difference was negligible (p = 0.956) in younger patients (<57 years). These results were consistent in patients with mild AR at implantation, including the increased risk of significant AR for uncorrected AR (p = 0.058), as well as improved survival with AR correction in the older population (p = 0.054), but no survival difference in the younger population (p = 0.492).

In older patients, correction of pre-existing AR, including mild AR, may improve long-term survival after LVAD implantation.