Abstract 20359: Long Term Valvular Outcomes With Patients Supported With HVAD and HeatMate II LVADS
Purpose: The natural history of mitral and tricuspid insufficiency at LVAD implantation and the progression of aortic insufficiency (AI) with continuous flow cfLVADs may alter the effectiveness of prolonged VAD support. To date, no study has examined differences in valvular outcomes between different cfLVADs.
Methods: We retrospectively reviewed echocardiographic assessments from primary HeartMate II (HMII) or HVAD LVAD implants between 1/16/09 and 5/24/13. We estimated the effect of cfLVADs on valvular function by calculating the change in valve dysfunction from the preoperative to the last postoperative assessment. A chi-square test was used for categorical variables and a t-test was used for continuous variables.
Results: The average follow up in days for HMII patients (n=151) was 307.3 +/- 310.8and 208.1 +/- 235.6 for HVAD patients (n=21) (p=0.102). The average age was 55.5 +/- 13.5 and 59.0 +/- 12.1 for HMII and HVAD respectively (p=0.093). Pulmonary artery systolic pressures (PASP) were not different between the groups at implant. Post implantation, a significantly lower percentage of HVAD patients experienced worsened AI with a total of 20.0% progressing 1 (10.0%) or 2 (10.0%) grades vs a total of 38.8% in the HMII group progressed by 1 (8.3%), 2 (27.1%), and 3 (3.5%) grades (p=0.03). No difference was seen between devices regarding the change in mitral or tricuspid valve function (p=0.38 and p=0.42, respectively). No patient in either group underwent isolated procedures for AI. Post implant, both devices significantly improved PASP (p=0.00001), with HVAD (n=14) further reducing PASP (24.0 +/- 8.6 mmHg) compared to HMII (n=117) mean PASP of 31.2 +/- 10.7 mmHg (p= 0.01).
Conclusions: Progression of AI was significantly less in HVAD patients compared to HMII patients. Mitral insufficiency did not differ between the groups, but PASP was reduced further in HVAD patients suggesting greater unloading was achieved. The reason for the observed differences is not clear but may be related to mechanistic differences between pumps, differences in outflow graft sizes, or aortic anastomosis induced turbulence in the aortic root.
Author Disclosures: S.C. Silvestry: Consultant/Advisory Board; Modest; Heartware. Consultant/Advisory Board; Significant; Thoratec. A.D. Keith: None. T. Kazui: None. S.M. Joseph: Research Grant; Modest; Thoratec. G.A. Ewald: Consultant/Advisory Board; Modest; Heartware, Thoratec. A. Itoh: None.
- © 2014 by American Heart Association, Inc.