Absence of Aortic Valve Opening after Hemodynamic Ramp Optimization Study Does Not Impact LVAD Morbidity of Mortality

Purpose Aortic valve opening in patients supported by left ventricular assist devices (LVAD) preserves native valve geometry and structure and reduces rates of aortic insufficiency and need for aortic valve interventions. With LVAD speed optimization studies (Ramp studies) hemodynamic optimization can sometimes come at the expense of aortic valve opening. Here we explore the impact of aortic valve opening after optimization on morbidity and mortality. Methods LVAD Patients from a single institution underwent simultaneous echocardiographic (TTE) and hemodynamic LVAD ramp study. Patients were deemed optimized when their hemodynamic profile reached a target right atrial (RA) pressure 2.2L/min/m2. The impact of presence or absence of aortic valve opening on readmission-free survival, hemocompatibility related adverse events (HRAE)-free survival and overall survival at 3 years was determined. Results 113 LVAD patients were included in the analysis (62=HMII, 34=HVAD, 17 =HM3). Mean CI was 2.73L/min/m2, RAP 9.4mmHg and PCWP 13.7mmHg after optimization. 52 patients had absence of aortic valve opening at their set speed. There was no difference in overall survival (p = 0.89), HF admissions (p = 0.81) and HRAE (p = 0.85) at 3 years in those with and without aortic valve opening (Figure A-C). Conclusion Absence of aortic valve opening after LVAD speed optimization did not demonstrate more adverse events or LVAD-related morbidity and mortality compared to those who had aortic valve opening. Speed optimization should focus on hemodynamic optimization with less emphasis on aortic valve opening.