Skip to main content

15.09.2023 | Original Article

Safety and efficacy of aortic valvuloplasty for de novo aortic insufficiency in patients with a left-ventricular assist device

verfasst von: Naoki Tadokoro, Satoshi Kainuma, Naonori Kawamoto, Takashi Kakuta, Kohei Tonai, Hideyuki Shimizu, Tomoyuki Fujita, Satsuki Fukushima

Erschienen in: General Thoracic and Cardiovascular Surgery

Einloggen, um Zugang zu erhalten

Abstract

Objectives

Progression of aortic insufficiency during left-ventricular assist device (LVAD) support is a crucial topic. One treatment option is aortic valvuloplasty (AVP); however, there is controversy regarding its safety and efficacy. We investigated the safety and efficacy of AVP using the coaptation stitch method (Park’s stitch) performed for de novo aortic insufficiency.

Methods

Between 2013 and 2020, 175 consecutive patients underwent LVAD implantation, of which 7 patients [men, 2 (28.6%); median age, 55 years] underwent late-stage AVP. Two patients underwent AVP within 2 weeks, and the remaining six patients underwent AVP 3, 19, 24, 28, 42, and 49 months, respectively, after LVAD implantation.

Results

Preoperatively, the degree of aortic insufficiency was moderate in 6 (85.7%) patients and severe in 1 (14.3%) patient. AVP was technically successful in 6 (85.7%) patients, while one case of failed plasty was subsequently treated with bioprosthetic valve replacement. A 1-year post-AVP right heart catheterization study revealed a median pulmonary artery wedge pressure of 10.0 mmHg. No deaths or heart failure admissions occurred during the follow-up (median, 38.0 months). There was no aortic insufficiency in 2 (28.6%) patients; however, trivial AI was observed in 3 (42.8%) patients, and mild AI was observed in 1 (14.3%) patient 2 years postoperatively. However, at the 3-year follow-up, two patients developed an increase in AI grade from trivial to mild.

Conclusions

AVP using Park’s stitch was safe. It is critical to carefully observe the aortic valve during AVP surgery to ensure that AVP is appropriate.
Literatur
1.
Zurück zum Zitat Truby LK, Garan AR, Givens RC, Wayda B, Takeda K, Yuzefpolskaya M, et al. Aortic insufficiency during contemporary left ventricular assist device support: analysis of the INTERMACS registry. JACC Heart Fail. 2018;6:951–60. CrossRefPubMedPubMedCentral Truby LK, Garan AR, Givens RC, Wayda B, Takeda K, Yuzefpolskaya M, et al. Aortic insufficiency during contemporary left ventricular assist device support: analysis of the INTERMACS registry. JACC Heart Fail. 2018;6:951–60. CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA, et al. The 2013 international society for heart and lung transplantation guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013;32:157–87. CrossRefPubMed Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA, et al. The 2013 international society for heart and lung transplantation guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013;32:157–87. CrossRefPubMed
3.
Zurück zum Zitat Park SJ, Liao KK, Segurola R, Madhu KP, Miller LW. Management of aortic insufficiency in patients with left ventricular assist devices: a simple coaptation stitch method (Park’s stitch). J Thorac Cardiovasc Surg. 2004;127:264–6. CrossRefPubMed Park SJ, Liao KK, Segurola R, Madhu KP, Miller LW. Management of aortic insufficiency in patients with left ventricular assist devices: a simple coaptation stitch method (Park’s stitch). J Thorac Cardiovasc Surg. 2004;127:264–6. CrossRefPubMed
4.
Zurück zum Zitat Robertson JO, Naftel DC, Myers SL, Prasad S, Mertz GD, Itoh A, et al. Concomitant aortic valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: an INTERMACS database analysis. J Heart Lung Transplant. 2015;34:797–805. CrossRefPubMed Robertson JO, Naftel DC, Myers SL, Prasad S, Mertz GD, Itoh A, et al. Concomitant aortic valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: an INTERMACS database analysis. J Heart Lung Transplant. 2015;34:797–805. CrossRefPubMed
5.
Zurück zum Zitat Cowger J, Rao V, Massey T, Sun B, May-Newman K, Jorde U, et al. Comprehensive review and suggested strategies for the detection and management of aortic insufficiency in patients with a continuous-flow left ventricular assist device. J Heart Lung Transplant. 2015;34:149–57. CrossRefPubMed Cowger J, Rao V, Massey T, Sun B, May-Newman K, Jorde U, et al. Comprehensive review and suggested strategies for the detection and management of aortic insufficiency in patients with a continuous-flow left ventricular assist device. J Heart Lung Transplant. 2015;34:149–57. CrossRefPubMed
6.
Zurück zum Zitat Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777–802. CrossRefPubMed Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777–802. CrossRefPubMed
7.
Zurück zum Zitat Veenis JF, Yalcin YC, Brugts JJ, Constantinescu AA, Manintveld OC, Bekkers JA, et al. Survival following a concomitant aortic valve procedure during left ventricular assist device surgery: an ISHLT mechanically assisted circulatory support (IMACS) registry analysis. Eur J Heart Fail. 2020;22:1878–87. CrossRefPubMed Veenis JF, Yalcin YC, Brugts JJ, Constantinescu AA, Manintveld OC, Bekkers JA, et al. Survival following a concomitant aortic valve procedure during left ventricular assist device surgery: an ISHLT mechanically assisted circulatory support (IMACS) registry analysis. Eur J Heart Fail. 2020;22:1878–87. CrossRefPubMed
8.
Zurück zum Zitat Fukuhara S, Takeda K, Chiuzan C, Han J, Polanco AR, Yuzefpolskaya M, et al. Concomitant aortic valve repair with continuous-flow left ventricular assist devices: results and implications. J Thorac Cardiovasc Surg. 2016;151(201–9):10.e1-2. Fukuhara S, Takeda K, Chiuzan C, Han J, Polanco AR, Yuzefpolskaya M, et al. Concomitant aortic valve repair with continuous-flow left ventricular assist devices: results and implications. J Thorac Cardiovasc Surg. 2016;151(201–9):10.e1-2.
9.
Zurück zum Zitat Schechter MA, Joseph JT, Krishnamoorthy A, Finet JE, Ganapathi AM, Lodge AJ, et al. Efficacy and durability of central oversewing for treatment of aortic insufficiency in patients with continuous-flow left ventricular assist devices. J Heart Lung Transplant. 2014;33:937–42. CrossRefPubMed Schechter MA, Joseph JT, Krishnamoorthy A, Finet JE, Ganapathi AM, Lodge AJ, et al. Efficacy and durability of central oversewing for treatment of aortic insufficiency in patients with continuous-flow left ventricular assist devices. J Heart Lung Transplant. 2014;33:937–42. CrossRefPubMed
10.
Zurück zum Zitat Barth M, Mrozek L, Niazy N, Selig JI, Boeken U, Sugimura Y, et al. Degenerative changes of the aortic valve during left ventricular assist device support. ESC Heart Fail. 2022;9:270–82. CrossRefPubMed Barth M, Mrozek L, Niazy N, Selig JI, Boeken U, Sugimura Y, et al. Degenerative changes of the aortic valve during left ventricular assist device support. ESC Heart Fail. 2022;9:270–82. CrossRefPubMed
11.
Zurück zum Zitat Hata H, Fujita T, Ishibashi-Ueda H, Nakatani T, Kobayashi J. Pathological analysis of the aortic valve after long-term left ventricular assist device support. Eur J Cardiothorac Surg. 2014;46:193–7. CrossRefPubMed Hata H, Fujita T, Ishibashi-Ueda H, Nakatani T, Kobayashi J. Pathological analysis of the aortic valve after long-term left ventricular assist device support. Eur J Cardiothorac Surg. 2014;46:193–7. CrossRefPubMed
12.
Zurück zum Zitat Tang PC, Sarsour N, Haft JW, Romano MA, Konerman M, Colvin M, et al. Aortic valve repair versus replacement associated with durable left ventricular assist devices. Ann Thorac Surg. 2020;110:1259–64. CrossRefPubMed Tang PC, Sarsour N, Haft JW, Romano MA, Konerman M, Colvin M, et al. Aortic valve repair versus replacement associated with durable left ventricular assist devices. Ann Thorac Surg. 2020;110:1259–64. CrossRefPubMed
13.
Zurück zum Zitat Nishida H, Song T, Onsager D, Nguyen A, Grinstein J, Chung B, et al. Proximal ascending aorta size is associated with the incidence of de novo aortic insufficiency with left ventricular assist device. Heart Vessels. 2022;37:647–53. CrossRefPubMed Nishida H, Song T, Onsager D, Nguyen A, Grinstein J, Chung B, et al. Proximal ascending aorta size is associated with the incidence of de novo aortic insufficiency with left ventricular assist device. Heart Vessels. 2022;37:647–53. CrossRefPubMed
14.
Zurück zum Zitat Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg. 2006;132:436–8. CrossRefPubMed Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg. 2006;132:436–8. CrossRefPubMed
15.
Zurück zum Zitat Boodhwani M, de Kerchove L, Glineur D, Poncelet A, Rubay J, Astarci P, et al. Repair-oriented classification of aortic insufficiency: impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg. 2009;137:286–94. CrossRefPubMed Boodhwani M, de Kerchove L, Glineur D, Poncelet A, Rubay J, Astarci P, et al. Repair-oriented classification of aortic insufficiency: impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg. 2009;137:286–94. CrossRefPubMed
16.
Zurück zum Zitat Imamura T, Burkhoff D, Rodgers D, Adatya S, Sarswat N, Kim G, et al. Repeated ramp tests on stable LVAD patients reveal patient-specific hemodynamic fingerprint. Asaio J. 2018;64:701–7. CrossRefPubMed Imamura T, Burkhoff D, Rodgers D, Adatya S, Sarswat N, Kim G, et al. Repeated ramp tests on stable LVAD patients reveal patient-specific hemodynamic fingerprint. Asaio J. 2018;64:701–7. CrossRefPubMed
17.
Zurück zum Zitat Imamura T, Narang N, Kim G, Nitta D, Fujino T, Nguyen A, et al. Impact of worsening of aortic insufficiency during HeartMate 3 LVAD support. Artif Organs. 2021;45:297–302. CrossRefPubMed Imamura T, Narang N, Kim G, Nitta D, Fujino T, Nguyen A, et al. Impact of worsening of aortic insufficiency during HeartMate 3 LVAD support. Artif Organs. 2021;45:297–302. CrossRefPubMed
18.
Zurück zum Zitat Kagawa H, Aranda-Michel E, Kormos RL, Keebler M, Hickey G, Wang Y, et al. Aortic insufficiency after left ventricular assist device implantation: predictors and outcomes. Ann Thorac Surg. 2020;110:836–43. CrossRefPubMed Kagawa H, Aranda-Michel E, Kormos RL, Keebler M, Hickey G, Wang Y, et al. Aortic insufficiency after left ventricular assist device implantation: predictors and outcomes. Ann Thorac Surg. 2020;110:836–43. CrossRefPubMed
19.
Zurück zum Zitat Jimenez Contreras F, Mendiola Pla M, Schroder J, Bryner B, Agarwal R, Russell SD, et al. Progression of aortic valve insufficiency during centrifugal versus axial flow left ventricular assist device support. Eur J Cardiothorac Surg. 2022;61:1188–96. CrossRefPubMed Jimenez Contreras F, Mendiola Pla M, Schroder J, Bryner B, Agarwal R, Russell SD, et al. Progression of aortic valve insufficiency during centrifugal versus axial flow left ventricular assist device support. Eur J Cardiothorac Surg. 2022;61:1188–96. CrossRefPubMed
20.
Zurück zum Zitat Mehra MR, Uriel N, Naka Y, Cleveland JC Jr, Yuzefpolskaya M, Salerno CT, et al. A fully magnetically levitated left ventricular assist device—final report. N Engl J Med. 2019;380:1618–27. CrossRefPubMed Mehra MR, Uriel N, Naka Y, Cleveland JC Jr, Yuzefpolskaya M, Salerno CT, et al. A fully magnetically levitated left ventricular assist device—final report. N Engl J Med. 2019;380:1618–27. CrossRefPubMed
21.
Zurück zum Zitat Scott M, Vesely I. Aortic valve cusp microstructure: the role of elastin. Ann Thorac Surg. 1995;60:S391–4. CrossRefPubMed Scott M, Vesely I. Aortic valve cusp microstructure: the role of elastin. Ann Thorac Surg. 1995;60:S391–4. CrossRefPubMed
22.
Metadaten
Titel
Safety and efficacy of aortic valvuloplasty for de novo aortic insufficiency in patients with a left-ventricular assist device
verfasst von
Naoki Tadokoro
Satoshi Kainuma
Naonori Kawamoto
Takashi Kakuta
Kohei Tonai
Hideyuki Shimizu
Tomoyuki Fujita
Satsuki Fukushima
Publikationsdatum
15.09.2023
Verlag
Springer Nature Singapore
Erschienen in
General Thoracic and Cardiovascular Surgery
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-023-01974-z

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.

S2k-Leitlinie "Operative Therapie des primären und renalen Hyperparathyreoidismus”

CME-Kurs
CME: 2 Punkte

Prof. Dr. med. Kerstin Lorenz
Lernziele des Webinars zur operativen Therapie des primären und renalen Hyperparathyreoidismus sind die wichtigsten klinischen Erscheinungsformen des Hyperparathyreoidismus und ihre Symptome kennenzulernen. Für die wesentlichen Erkrankungsformen sollen die erforderlichen präoperativen Diagnostikverfahren zur Lokalisation und Differentialdiagnosen und jeweils die Indikationen zur Operation deutlich gemacht werden. Zudem sollen die zugehörigen Operationsverfahren und technische Spezifika vorgestellt werden.

Prof. Dr. med. Kerstin Lorenz
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Schultersteife“

CME: 2 Punkte

In diesem Webinar soll über die verschiedenen Ursachen einer Schultersteife, die Diagnostik und die Therapieansätze berichtet werden. Was ist klinisch eine gesicherte Therapie, was sollte lieber unterlassen werden. Es wird dabei gleichermaßen auf die konservative wie operative Therapie eingegangen. Der Schwerpunkt wird auf die Behandlung und weniger auf wissenschaftliche Grundlagen gelegt.

PD Dr. med. Carsten Englert
Berufsverband der Deutschen Chirurgie e.V.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.