Aortic Valve Pathology in Patients Supported by Continuous-Flow Left Ventricular Assist Device

Background:Continuous-flow left ventricular assist devices (CF-LVAD) may induce pathological changes to the aortic wall and aortic valve. We assessed histological changes in the relevant anatomic structures exposed to continuous flow over time and compared the histological results with clinical feat...

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Bibliographic Details
Published in:Circulation Journal 2016/05/25, Vol.80(6), pp.1371-1377
Main Authors: Saito, Tomohiro, Wassilew, Katharina, Gorodetski, Boris, Stein, Julia, Falk, Volkmar, Krabatsch, Thomas, Potapov, Evgenij
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aortic Valve - pathology
Aortic valve regurgitation and pathology
Assisted circulation
Female
Heart Transplantation - adverse effects
Heart-Assist Devices - adverse effects
Humans
Male
Middle Aged
Retrospective Studies
Time Factors
Ventricular assist device
Ventricular Function, Left
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Summary:Background:Continuous-flow left ventricular assist devices (CF-LVAD) may induce pathological changes to the aortic wall and aortic valve. We assessed histological changes in the relevant anatomic structures exposed to continuous flow over time and compared the histological results with clinical features in patients supported with CF-LVAD.Methods and Results:A retrospective histological analysis was performed of 38 explanted hearts supported with CF-LVAD from patients who received heart transplantation between July 2003 and February 2014. Sections of formalin-fixed paraffin-embedded tissue showing the continuity of aortic wall and left-sided valves were examined histologically. Thickness of aorta, aortic root and aortic valve as well as 3 layers of the aortic cusps were measured individually on Elastica van Gieson-stained slides using specific software. Clinical parameters concerning aortic valve dysfunction were evaluated and validated against the histology. The aortic valve spongiosa and fibrosa layers showed no significant differences in thickness with regard to support duration or occurrence of aortic insufficiency. Longer CF-LVAD support duration correlated with a thinner aortic valve ventricularis layer (rS=–0.496).Conclusions:Long-term CF-LVAD support appears to cause involution of the ventricularis layer of the aortic valve cusp, consistent with more pronounced degenerative change with longer LVAD exposure, which may be explained by continuous coaptation of the cusps. (Circ J 2016; 80: 1371–1377)
ISSN:1346-9843
1347-4820
DOI:10.1253/circj.CJ-15-1188