Fusion of Aortic Valve Commissures in Patients Supported by a Continuous Axial Flow Left Ventricular Assist Device

James Mudd, Jonathan D. Cuda, Marc Halushka, Karl A. Soderlund, John V. Conte, Stuart D. Russell

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

Background: Left ventricular assist devices (LVADs) are an important therapy for selected individuals with advanced heart failure unable to wait for a suitable donor for transplantation. Pulsatile LVADs are associated with commissural fusion of the aortic valve, yet little is known about this association with newer generation continuous axial flow LVADs. Methods: We retrospectively reviewed pathologic samples from 9 patients enrolled in the HeartMate II Bridge to Transplantation Trial. Echocardiograms at 1, 6 and 12 months after device placement were evaluated for aortic valve opening and aortic insufficiency. At the time of transplantation, explanted hearts were examined for gross pathologic valvular abnormalities and histologic analysis. Results: All but 1 explant had evidence of commissural fusion of the native aortic valve leaflets. Over time there was a decreasing prevalence of aortic valve opening and an increasing prevalence of mild to moderate aortic insufficiency independent of pump speed. All patients had improvements in their functional status and were successfully bridged to orthotopic heart transplantation. Conclusions: Commissural fusion of the native aortic valve leaflets occurs frequently with an increasing prevalence of aortic insufficiency during continuous flow LVAD support. With the potential broader use of non-pulsatile LVADs and the prospect of using LVADs as means to assist in myocardial recovery, special attention should be given to evaluating aortic valve function during LVAD support.

Original languageEnglish (US)
Pages (from-to)1269-1274
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume27
Issue number12
DOIs
StatePublished - Dec 2008
Externally publishedYes

Fingerprint

Heart-Assist Devices
Aortic Valve
Heart Transplantation
Transplantation
Heart Failure
Tissue Donors
Equipment and Supplies

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Fusion of Aortic Valve Commissures in Patients Supported by a Continuous Axial Flow Left Ventricular Assist Device. / Mudd, James; Cuda, Jonathan D.; Halushka, Marc; Soderlund, Karl A.; Conte, John V.; Russell, Stuart D.

In: Journal of Heart and Lung Transplantation, Vol. 27, No. 12, 12.2008, p. 1269-1274.

Research output: Contribution to journalArticle

Mudd, James ; Cuda, Jonathan D. ; Halushka, Marc ; Soderlund, Karl A. ; Conte, John V. ; Russell, Stuart D. / Fusion of Aortic Valve Commissures in Patients Supported by a Continuous Axial Flow Left Ventricular Assist Device. In: Journal of Heart and Lung Transplantation. 2008 ; Vol. 27, No. 12. pp. 1269-1274.
@article{c201063b19fb4bfb90c28f3e64fbe9c9,
title = "Fusion of Aortic Valve Commissures in Patients Supported by a Continuous Axial Flow Left Ventricular Assist Device",
abstract = "Background: Left ventricular assist devices (LVADs) are an important therapy for selected individuals with advanced heart failure unable to wait for a suitable donor for transplantation. Pulsatile LVADs are associated with commissural fusion of the aortic valve, yet little is known about this association with newer generation continuous axial flow LVADs. Methods: We retrospectively reviewed pathologic samples from 9 patients enrolled in the HeartMate II Bridge to Transplantation Trial. Echocardiograms at 1, 6 and 12 months after device placement were evaluated for aortic valve opening and aortic insufficiency. At the time of transplantation, explanted hearts were examined for gross pathologic valvular abnormalities and histologic analysis. Results: All but 1 explant had evidence of commissural fusion of the native aortic valve leaflets. Over time there was a decreasing prevalence of aortic valve opening and an increasing prevalence of mild to moderate aortic insufficiency independent of pump speed. All patients had improvements in their functional status and were successfully bridged to orthotopic heart transplantation. Conclusions: Commissural fusion of the native aortic valve leaflets occurs frequently with an increasing prevalence of aortic insufficiency during continuous flow LVAD support. With the potential broader use of non-pulsatile LVADs and the prospect of using LVADs as means to assist in myocardial recovery, special attention should be given to evaluating aortic valve function during LVAD support.",
author = "James Mudd and Cuda, {Jonathan D.} and Marc Halushka and Soderlund, {Karl A.} and Conte, {John V.} and Russell, {Stuart D.}",
year = "2008",
month = "12",
doi = "10.1016/j.healun.2008.05.029",
language = "English (US)",
volume = "27",
pages = "1269--1274",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "12",

}

TY - JOUR

T1 - Fusion of Aortic Valve Commissures in Patients Supported by a Continuous Axial Flow Left Ventricular Assist Device

AU - Mudd, James

AU - Cuda, Jonathan D.

AU - Halushka, Marc

AU - Soderlund, Karl A.

AU - Conte, John V.

AU - Russell, Stuart D.

PY - 2008/12

Y1 - 2008/12

N2 - Background: Left ventricular assist devices (LVADs) are an important therapy for selected individuals with advanced heart failure unable to wait for a suitable donor for transplantation. Pulsatile LVADs are associated with commissural fusion of the aortic valve, yet little is known about this association with newer generation continuous axial flow LVADs. Methods: We retrospectively reviewed pathologic samples from 9 patients enrolled in the HeartMate II Bridge to Transplantation Trial. Echocardiograms at 1, 6 and 12 months after device placement were evaluated for aortic valve opening and aortic insufficiency. At the time of transplantation, explanted hearts were examined for gross pathologic valvular abnormalities and histologic analysis. Results: All but 1 explant had evidence of commissural fusion of the native aortic valve leaflets. Over time there was a decreasing prevalence of aortic valve opening and an increasing prevalence of mild to moderate aortic insufficiency independent of pump speed. All patients had improvements in their functional status and were successfully bridged to orthotopic heart transplantation. Conclusions: Commissural fusion of the native aortic valve leaflets occurs frequently with an increasing prevalence of aortic insufficiency during continuous flow LVAD support. With the potential broader use of non-pulsatile LVADs and the prospect of using LVADs as means to assist in myocardial recovery, special attention should be given to evaluating aortic valve function during LVAD support.

AB - Background: Left ventricular assist devices (LVADs) are an important therapy for selected individuals with advanced heart failure unable to wait for a suitable donor for transplantation. Pulsatile LVADs are associated with commissural fusion of the aortic valve, yet little is known about this association with newer generation continuous axial flow LVADs. Methods: We retrospectively reviewed pathologic samples from 9 patients enrolled in the HeartMate II Bridge to Transplantation Trial. Echocardiograms at 1, 6 and 12 months after device placement were evaluated for aortic valve opening and aortic insufficiency. At the time of transplantation, explanted hearts were examined for gross pathologic valvular abnormalities and histologic analysis. Results: All but 1 explant had evidence of commissural fusion of the native aortic valve leaflets. Over time there was a decreasing prevalence of aortic valve opening and an increasing prevalence of mild to moderate aortic insufficiency independent of pump speed. All patients had improvements in their functional status and were successfully bridged to orthotopic heart transplantation. Conclusions: Commissural fusion of the native aortic valve leaflets occurs frequently with an increasing prevalence of aortic insufficiency during continuous flow LVAD support. With the potential broader use of non-pulsatile LVADs and the prospect of using LVADs as means to assist in myocardial recovery, special attention should be given to evaluating aortic valve function during LVAD support.

UR - http://www.scopus.com/inward/record.url?scp=57049163522&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=57049163522&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2008.05.029

DO - 10.1016/j.healun.2008.05.029

M3 - Article

VL - 27

SP - 1269

EP - 1274

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 12

ER -