Tohoku J. Exp. Med., 2021 November, 255(3)

Aortic Insufficiency Causes Symptomatic Heart Failure during Left Ventricular Assist Device Support

Masaaki Naganuma,¹ Masatoshi Akiyama,¹ Konosuke Sasaki,¹ Kay Maeda,¹ Koki Ito,¹ Tomoyuki Suzuki,¹ Shintaro Katahira,¹ Yusuke Suzuki¹ and Yoshikatsu Saiki¹

¹Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

De novo aortic insufficiency is often documented during long-term left ventricular assist device (LVAD) support, despite the absence of aortic insufficiency at the time of LVAD implantation. However, whether aortic insufficiency affects long-term mortality and symptomatic heart failure in LVAD-supported patients remains controversial. We aimed to examine whether aortic insufficiency development influenced mortality and symptomatic heart failure following LVAD implantation. Fifty-three patients who underwent durable LVAD implantation between January 1, 2008 and April 31, 2017 were retrospectively examined in a single center institute. After discharge, we performed the echocardiographic examination in accordance with the Japanese registry for the mechanically assisted circulatory support protocol. Aortic insufficiency was graded on an interval scale (severe = 4, moderate = 3, mild = 2, trivial or none = 1). Kaplan-Meier estimates for long-term mortality at the follow-up were generated. We used a logistic regression model to identify risk factors for symptomatic heart failure. The overall median duration of LVAD support was 856.3 ± 430.8 days (range, 12-1,744 days). We did not observe a significant difference in long-term mortality in patients with aortic insufficiency ≥ 3 grade compared with patients with aortic insufficiency < 3 grade (P = 0.767; log-rank). Aortic insufficiency was associated with an increased risk for heart failure event after discharge (odds ratio, 4.12; confidence interval, 1.48-16.93; P = 0.005). Aortic insufficiency was an independent risk factor for symptomatic heart failure and was not associated with long-term mortality. Aortic insufficiency progression was associated with symptomatic heart failure.

Keywords —— aortic insufficiency; end-stage heart failure; left ventricular assist device; readmission; symptomatic heart failure

© 2021 Tohoku University Medical Press

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Tohoku J. Exp. Med 2021, 255, 229-237.

Correspondence: Yoshikatsu Saiki, M.D., Ph.D., Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.

e-mail: yoshisaiki@med.tohoku.ac.jp