BACKGROUND

After 3 years of continuous-flow left ventricular assist device (CF-LVAD) support, nearly a third of patients develop at least moderate aortic insufficiency (AI). Percutaneous occluder devices, surgical aortic valve replacement (SAVR), and urgent heart transplantation are available treatment options. Transcatheter aortic valve replacement (TAVR) has not been widely used for treating symptomatic AI in patients on LVAD support.

METHODS

Retrospective chart review and data analysis from October 2010 through August 2017 was performed. A total of 286 patients with end-stage heart failure (ESHF) were implanted with a durable CF-LVAD. Nine patients subsequently developed significant symptomatic AI, which was treated with TAVR.

RESULTS

All 9 patients had 1 TAVR procedure with resolution of AI and were discharged home. Procedural complications include valve migration warranting a second valve for stabilization, retroperitoneal and groin hematoma, and pseudoaneurysm requiring thrombin injection. A significant improvement of the New York Heart Association classification was noted from the time of implant to 6 months. Two patients had unplanned heart failure‒related hospitalizations within 6 months. At 6 months, 89% of patients were alive on LVAD support.

CONCLUSIONS

TAVR is a successful treatment modality for LVAD patients who develop symptomatic AI.

中文翻译：

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经导管主动脉瓣置换术治疗有症状主动脉功能不全的左心室辅助装置患者的近期结果。

背景

经过3年连续流左心室辅助装置（CF-LVAD）的支持，近三分之一的患者至少发展为中度主动脉瓣关闭不全（AI）。经皮封堵器设备，外科主动脉瓣置换术（SAVR）和紧急心脏移植是可用的治疗选择。经导管主动脉瓣置换术（TAVR）尚未广泛用于治疗接受LVAD支持的患者的症状性AI。

方法

从2010年10月至2017年8月进行了回顾性图表审查和数据分析。总共286例终末期心力衰竭（ESHF）患者植入了耐用的CF-LVAD。随后有9名患者出现明显的症状性AI，并接受TAVR治疗。

结果

所有9例患者均接受了1例AI分辨率的TAVR手术，均已出院。程序上的并发症包括瓣膜迁移，需要第二个瓣膜以稳定，腹膜后和腹股沟血肿，以及需要凝血酶注射的假性动脉瘤。从植入时间到6个月，纽约心脏协会的分类得到了显着改善。2例患者在6个月内进行了计划外的心力衰竭相关的住院治疗。在6个月时，有89％的患者在LVAD支持下还活着。

结论

对于出现症状性AI的LVAD患者，TAVR是一种成功的治疗方式。