Romero Dorta Elena, Meyn Robert, Müller Markus, Hoermandinger Christoph, Schoenrath Felix, Falk Volkmar, Meyer Alexander, Merke Nicolas, Potapov Evgenij, Mulzer Johanna, Knierim Jan
Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin, Germany.
Artif Organs. 2025 Mar;49(3):441-450. doi: 10.1111/aor.14891. Epub 2024 Oct 25.
Aortic regurgitation (AR) is a well-known cause of impaired outcome in patients with centrifugal left ventricular assist devices (cfLVADs). The failure of the aortic valve (AV) to open at least intermittently is associated with cusp remodeling, commissural fusion, and ultimately developing AR. Our aim was to characterize patients in whom AV opening (AVO) was preserved 6 months after implantation and identify determinants related to it.
We conducted standardized echocardiography and collected clinical and laboratory tests at the outpatient clinic 6 months after implantation. We classified patients into those showing intermittently opening of the AV, every 2-3 beats, or in every cycle (AVO) and those whose AV was continuously closed (NAVO). From the 219 cfLVAD implanted in our center between March 2018 and January 2020, 156 subjects were alive and on the device after 6 months. In 2 of the reviewed echocardiograms, we could not evaluate the AV. 99 patients (64%) showed AVO compared to 55 (36%) with NAVO. The first presented higher mean arterial pressure (84 ± 10 vs. 77 ± 13 mm Hg, p = 0.002), larger LV end-diastolic diameter (LVEDD 57.5 ± 12 vs. 52.7 ± 13 mm, p = 0.022), a better TAPSE (15 ± 4 vs. 13 ± 4 mm, p = 0.028), and less frequently significant AR than patients with NAVO (moderate/severe AR in 6% vs. in 20%, p = 0.042). In a multiple logistic regression, a lower NYHA Class, a larger LVEDD, and a better LV ejection fraction appeared as significant predictors of AVO. After a median follow-up of 3.2 years, we found no significant impact on survival stratifying patients by AVO (log-rank p = 0.53).
AVO was associated with better RV function, lower NYHA Class, and a lower rate of significant AR. This could indicate that AVO should be pursued in LVAD patients.
主动脉瓣反流（AR）是离心式左心室辅助装置（cfLVAD）患者预后不良的一个众所周知的原因。主动脉瓣（AV）至少间歇性无法打开与瓣叶重塑、瓣叶融合相关，并最终发展为AR。我们的目的是对植入后6个月时AV开放（AVO）得以保留的患者进行特征描述，并确定与之相关的决定因素。
我们在植入后6个月的门诊进行了标准化超声心动图检查，并收集了临床和实验室检查结果。我们将患者分为AV每2 - 3次心跳或每个心动周期间歇性开放（AVO）的患者，以及AV持续关闭（NAVO）的患者。在2018年3月至2020年1月期间于我们中心植入的219例cfLVAD中，156例患者在6个月后存活且仍使用该装置。在2份回顾的超声心动图中，我们无法评估AV。99例患者（64%）表现为AVO，而55例（36%）表现为NAVO。与NAVO患者相比，AVO患者的平均动脉压更高（84±10 vs. 77±13 mmHg，p = 0.002），左心室舒张末期直径更大（LVEDD 57.5±12 vs. 52.7±13 mm，p = 0.022），三尖瓣环平面收缩期位移（TAPSE）更好（15±4 vs. 13±4 mm，p = 0.028），且显著AR的发生率更低（中度/重度AR在AVO患者中为6%，在NAVO患者中为20%，p = 0.042）。在多因素逻辑回归分析中，较低的纽约心脏协会（NYHA）分级、较大的LVEDD和较好的左心室射血分数是AVO的显著预测因素。在中位随访3.2年后，我们发现根据AVO对患者进行生存分层没有显著影响（对数秩检验p = 0.53）。
AVO与更好的右心室功能、较低的NYHA分级和较低的显著AR发生率相关。这可能表明在LVAD患者中应追求AVO。
