P97: Concomitant Aortic Valve Replacement and Left Ventricular Assist Device Implantation in Patients with Aortic Insufficiency

Background: Preoperative aortic insufficiency (AI) is one of the most important predictors of progression to moderate to severe AI during left ventricular assist device (LVAD) support. Our group has aggressively corrected preexistent AI, including mild AI, with bioprosthetic aortic valve replacement (AVR). We analyzed the operative and postoperative results of our patients. Methods: We reviewed data of all patients who underwent LVAD implantation and had concomitant AVR in our center between May 2012 and June 2022. We used either a St. Jude or Edwards bioprosthetic aortic valve. Results: Twenty-five patients (19 men, 6 women) with an average age of 61±12 years had concomitant AVR and LVAD implantation (23 patients as destination therapy and 2 as bridge to transplantation). Eight patients were INTERMACS profile 1, 12 profile 2, and 5 profile 3. Twelve patients had mild, 7 mild to moderate, 4 moderate, 1 moderate to severe and 1 severe AVI. Cardiopulmonary bypass time was on average 136±30 min with cross-clamp time of 63±19 min. The median length of stay after LVAD implantation was 24 (IQR 19-32) days. Target INR ranged from 2 to 3. Five patients had gastrointestinal bleeding; thus, their INR target was between 1.8 -2.2. Four patients had strokes 66, 105, 762 and 1127 days after implantation. The median length of LVAD support was 1143 (range 33-2470) days. One patient died in the hospital 33 days after surgery due to nonischemic bowel perforation-related sepsis. Three other patients died 469, 772 and 1710 days after LVAD implantation. Six patients had heart transplantation. Fifteen patients are alive on LVAD support with a median of 1290 days (range 231 to 2470). All 22 patients who reached 1-year follow-up had normal aortic values with 2 patients having trace and 4 mild AI starting 6 months after AVR. One patient had a valvular thrombus 15 months after surgery. Conclusion: Utilization of concomitant bioprosthetic AVR in patients undergoing LVAD implant who had mild to severe AI seems not to be harmful to patient postoperative management or survival.