PMID- 25069685
OWN - NLM
STAT- MEDLINE
DCOM- 20141103
LR  - 20140906
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 98
IP  - 3
DP  - 2014 Sep
TI  - De novo aortic regurgitation after continuous-flow left ventricular assist device 
      implantation.
PG  - 850-7
LID - S0003-4975(14)01082-0 [pii]
LID - 10.1016/j.athoracsur.2014.05.030 [doi]
AB  - BACKGROUND: Significant aortic regurgitation (AR) after continuous-flow left 
      ventricular assist device (cf-LVAD) placement affects device performance and 
      patient outcomes. This study examined the development of AR and long-term results 
      after implantation of cf-LVADs. METHODS: The study included all patients with no 
      or less than mild AR who underwent HeartMate II (58 [62%]; Thoratec Corp, 
      Pleasanton, CA) or HeartWare (35 [38%]; HeartWare International, Framingham, MA) 
      implantation at our institute from July 2006 to July 2012. Serial echocardiograms 
      were obtained preoperatively, at 1, 3 and 6 months postoperatively, and then at a 
      minimum of 4-month intervals in patients with longer-term support. Kaplan-Meier 
      estimates for freedom from moderate or greater AR were generated. Logistic 
      regression analysis was used to define independent predictors of AR after cf-LVAD 
      implantation. RESULTS: Median duration of LVAD support was 527 days (25(th), 
      75(th): 289, 907; range, 60 to 2,433 days). Mild AR developed in 48 patients 
      (51.6%) over a median duration of 126 days, with progression to moderate AR in 13 
      (14%) over 493 days and to severe AR in 2 (2.1%) over 1,231 days. The incidence 
      of mild or greater AR was 43.1% in HeartMate II vs 65.7% in HeartWare recipients 
      (p = 0.035). Overall freedom from moderate or greater AR was 94.7% +/- 2.6% at 1 
      year, 86.9% +/- 4.5% at 2 years, 82.8% +/- 5.9% at 3 years, and 31% +/- 16.9% at 4 
      years. Independent predictors of AR were duration of support (odds ratio, 1.002; 
      95% confidence interval, 1.000 to 1.004; p = 0.017) and a persistently closed 
      aortic valve (odds ratio, 0.193; 95% confidence interval, 0.097 to 0.382; p < 
      0.001). CONCLUSIONS: AR is associated with longer cf-LVAD support duration and 
      persistent aortic valve closure. Incidence of moderate or greater AR after 
      cf-LVAD implantation increases significantly after 3 years. The clinical 
      implications of these data may warrant consideration of prophylactic aortic valve 
      replacement at the time of cf-LVAD implantation, particularly with expected 
      longer duration of support and in patients with preexisting AR that is more than 
      mild.
CI  - Copyright (c) 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Patil, Nikhil Prakash
AU  - Patil NP
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom. Electronic address: n.patil@rbht.nhs.uk.
FAU - Sabashnikov, Anton
AU  - Sabashnikov A
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom.
FAU - Mohite, Prashant N
AU  - Mohite PN
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom.
FAU - Garcia, Diana
AU  - Garcia D
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom.
FAU - Weymann, Alexander
AU  - Weymann A
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom.
FAU - Zych, Bartlomiej
AU  - Zych B
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom.
FAU - Bowles, Christopher T
AU  - Bowles CT
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom.
FAU - Hards, Rachel
AU  - Hards R
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom.
FAU - Hedger, Michael
AU  - Hedger M
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom.
FAU - Popov, Aron F
AU  - Popov AF
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom.
FAU - De Robertis, Fabio
AU  - De Robertis F
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom.
FAU - Moza, Ajay
AU  - Moza A
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom.
FAU - Bahrami, Toufan
AU  - Bahrami T
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom.
FAU - Amrani, Mohamed
AU  - Amrani M
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom.
FAU - Rahman-Haley, Shelley
AU  - Rahman-Haley S
AD  - Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS 
      Foundation Trust, London, United Kingdom.
FAU - Banner, Nicholas R
AU  - Banner NR
AD  - Department of Heart Failure and Transplant Medicine, Harefield Hospital, Royal 
      Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
FAU - Simon, Andre Rudiger
AU  - Simon AR
AD  - Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, 
      Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, 
      United Kingdom.
LA  - eng
PT  - Journal Article
DEP - 20140725
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adult
MH  - Aortic Valve Insufficiency/*etiology
MH  - Female
MH  - Heart-Assist Devices/*adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prosthesis Implantation/*adverse effects
MH  - Retrospective Studies
MH  - Time Factors
EDAT- 2014/07/30 06:00
MHDA- 2014/11/05 06:00
CRDT- 2014/07/30 06:00
PHST- 2014/01/03 00:00 [received]
PHST- 2014/04/17 00:00 [revised]
PHST- 2014/05/05 00:00 [accepted]
PHST- 2014/07/30 06:00 [entrez]
PHST- 2014/07/30 06:00 [pubmed]
PHST- 2014/11/05 06:00 [medline]
AID - S0003-4975(14)01082-0 [pii]
AID - 10.1016/j.athoracsur.2014.05.030 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2014 Sep;98(3):850-7. doi: 10.1016/j.athoracsur.2014.05.030. 
      Epub 2014 Jul 25.