Aortic Insufficiency Following Left Ventricular Assist Device Implantation: Predictors and Outcomes

Abstract Background The aim of this study was to evaluate the incidence, risk factors, and clinical impact of progression of aortic insufficiency (AI) after left ventricular assist device (LVAD) implantation. Methods Patients undergoing primary durable LVAD implantation between 2004-2018 were included. Significant AI was defined as more than mild AI. Clinical and echocardiographic data were collected. Patients were stratified by degree of pre-LVAD AI into 3 groups: no AI (I), trace AI (II), and mild AI (III). Results A total of 316 eligible patients underwent LVAD implant, including 229 (72.5%) patients in group I, 54 (17.1%) in group II, and 33 (10.4%) in group III. Median follow-up was 469 days. 42 (13.3%) patients progressed to significant AI during follow-up. Group III patients had the highest rate of developing significant AI (I: 10.0%, II: 13.0%, III: 36.4%; p=0.002). Freedom from significant AI at 1-year post-LVAD was 94.5% in group I, 86.1% in group II and 62.4% in group III (p Conclusions Although a minority of patients supported with an LVAD develop significant AI, this risk is increased in those with mild AI preoperatively. This finding, in conjunction with the increased mortality risk once significant AI develops, suggests that closer follow-up and management of LVAD patients with mild preoperative AI may be prudent.