Long-term Outcomes Of Transcatheter Aortic Valve Replacement For Aortic Insufficiency In Patients With Left Ventricular Assist Devices

• Published in: Journal of cardiac failure 2023-04, Vol.29 (4), p.623-623
• Main Authors: Quach, Kaitlyn, Shen, Christine, Parizo, Justin, Narula, Arvin
• Format: Article
• Language: English
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2022.10.190

Among patients who undergo implantation of a durable left ventricular assist device (LVAD) for end stage heart failure, nearly one third will develop aortic insufficiency (AI). When conservative therapy fails to manage symptomatic AI, transcatheter aortic valve replacement (TAVR) is a treatment option, but long-term outcomes are unclear. This is a single-center case series of consecutive patients with LVAD complicated by symptomatic, significant AI who underwent TAVR. Patients were identified through review of the electronic medical record from January 2017 through March 2022 and followed for 21 months. Seven patients with LVADs underwent TAVR for AI. The median age at the time of TAVR was 69 years (range 59-74) and median time from LVAD implant to TAVR was 544 days (range 357-3136). 14% were female, 71% were white, and 14% were Hispanic. Comorbidities included hypertension (71%), atrial fibrillation (86%), cerebral vascular accident (57%), and diabetes (29%). None of the included patients had aortic valve intervention during LVAD implant. Prior to TAVR, all of the patients had at least moderate AI. Post-TAVR, all patients had resolution of AI without significant peri-valvular leak. Complications included stroke in one patient leading to withdrawal of care 10 days post procedure and femoral artery hemorrhage requiring stenting in another. Two patients enrolled in hospice with ongoing end-stage heart failure at 407 and 450 days post procedure. At 1 year, six patients were alive and at 21 months, four patients were alive. Three of the four continued on LVAD support, while one underwent LVAD explant for improved heart failure. As survival post LVAD implant increases, native heart complications such as AI are expected to become increasingly common. TAVR is a viable treatment option for LVAD patients who develop symptomatic AI.