Aortic Valve Repair versus Replacement Associated with Durable Left Ventricular Assist Devices

Abstract Background Aortic valve repair (AVr) using a central coaptation stitch or bioprosthetic aortic valve replacement (AVR) are most commonly performed at the time of durable LVAD implant to address AV insufficiency (AI). Methods Prospective data collection on 46 patients undergoing LVAD implant from 2007 through 2018 who received concomitant AVr (n=40) or AVR (n=6) was retrospectively-analyzed to assess freedom from recurrent aortic insufficiency. Paired Wilcoxon rank sum test was used to compare echocardiographic findings. Mantel-Cox statistics were used to analyze survival. Results For AVr, central coaptation lead to a mean decrease in AI severity by 2.1 + 1.0 grades (P 3.5cm was predictive of less improvement in AI severity compared to 3.5cm (1.83 + 1.03 vs 2.47 + 0.80 grades of improvement, P=0.038). Duration of cardiopulmonary bypass was 32 minutes longer and duration of aortic cross-clamp 38 minutes longer for AVR versus AVr cohorts. No difference in 30 day (P=0.418) or overall survival (P=0.572) between the AVr and AVR groups was seen. Conclusions AVr for addressing AI has a recurrence rate of 7.5% at 3 years. Success in downgrading AI is more likely with a smaller aortic root. No difference in survival was observed between AVr and AVR.