Introduction:
Left ventricular assist devices (LVADs) have been shown to increase survival and quality of life in patients with end-stage congestive heart failure. However, severe aortic insufficiency (AI) can develop in up to 50% of patients with LVADs at 12 months resulting in significant morbidity and mortality. Trans-catheter treatment of LVAD associated AI has emerged as a potential alternative to surgical treatment, but long term clinical benefits are yet to be determined.
Methods:
We conducted a retrospective analysis of all patients undergoing trans-catheter aortic valve closure using an Amplatzer Multi-Fenestrated Septal Occluder “Cribiform” device (AGA Medical, Plymouth, Minnesota) at our institution between September 2011 and September 2013 to assess potential clinical and procedural factors associated with survival. Unpaired student’s t-tests were used to compare baseline patient demographics and procedural characteristics, as well as patient outcomes immediately post procedure and at 6 months. A p-value of <0.05 was considered statistically significant.
Results:
A total of 8 patients (75% male, median age 59 years) were included in this analysis. Technical success of the procedure including total cessation of AI without evidence of coronary compromise was accomplished in 100% of patients with a 6 month survival rate of 38% (3/8). Predictors of survival include the absence of significant co-morbidities such as chronic renal insufficiency, smaller occlusion device placement, and the absence of right heart failure (Table 1).
Conclusions:
Trans-catheter aortic valve closure successfully treats late severe AI in LVAD patients, however, the presence or development of right heart failure portends a worse prognosis. Further studies are needed to investigate the potential right ventricular failure in patients undergoing trans-catheter aortic valve closure.
TCT-379 Percutaneous Transcatheter Aortic Valve Closure Successfully Treats Left Ventricular Assist Device-Associated Aortic Insufficiency and Improves Cardiac Hemodynamics
