Predictors of survival following trans-catheter aortic valve closure for left ventricular assist device associated aortic insufficiency. Journal Article

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Authors: Retzer, EM; Sayer, GT; Fedson, SE; Nathan, S; Jeevanandam, V; Friant, J; Uriel, N; Lang, RM; Russo, MJ; Shah, AP
Article Title: Predictors of survival following trans-catheter aortic valve closure for left ventricular assist device associated aortic insufficiency.
Abstract: OBJECTIVE: This study sought to assess the long-term clinical benefits and predictors of survival of trans-catheter aortic valve closure in left ventricular assist device (LVAD) patients. BACKGROUND: LVADs have been shown to increase survival and quality of life in patients with end-stage heart failure. However, severe aortic insufficiency (AI) can develop in up to 50% of patients at 12 months resulting in significant morbidity and mortality. Trans-catheter treatment of LVAD associated AI has emerged as a potential alternative to surgical treatment. METHODS: We conducted a retrospective analysis of all patients undergoing trans-catheter aortic valve closure using an Amplatzer Multi-Fenestrated Septal Occluder "Cribriform" device to assess potential clinical and procedural factors associated with survival. Student's t-tests were used to compare baseline patient demographics and procedural characteristics, as well as patient outcomes immediately post procedure and at 6 months. A P-value of less than 0.05 was considered statistically significant. RESULTS: A total of 10 patients (70% male, median age 59 years) were included. Technical success was accomplished in 100% of patients with a 6 month survival rate of 30% (3/10). Compared with survivors, non-survivors had a higher rate of pre-procedural clinical co-morbidities, an increased likelihood of right ventricular failure, and received larger occluder devices. CONCLUSIONS: Trans-catheter aortic valve closure successfully treats late severe AI in LVAD patients, however, the presence or development of right heart failure portends a worse prognosis. Further studies are needed to investigate the factors involved in the development of right ventricular failure, and potential treatment, in patients undergoing trans-catheter aortic valve closure.
Journal Title: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography Interventions
ISSN: 1522-726X; 1522-1946
Publisher: Unknown  
Date Published: 2016