Gliozzi Gregorio, Nersesian Gaik, Gallone Guglielmo, Schoenrath Felix, Netuka Ivan, Zimpfer Daniel, de By Theo M M H, Faerber Gloria, Spitaleri Antonio, Vendramin Igor, Gummert Jan, Falk Volkmar, Meyns Bart, Rinaldi Mauro, Potapov Evgenij, Loforte Antonio
Cardiac Surgery Unit, Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
Department of Medical and Surgical Sciences (DIMES), Alma Mater Studiorum - University of Bologna, Bologna, Italy.
Artif Organs. 2025 Apr;49(4):691-704. doi: 10.1111/aor.14926. Epub 2024 Dec 10.
Left ventricular assist device (LVAD) therapy may lead to an aortic regurgitation, limiting left ventricular unloading and causing adverse events. Whether concomitant aortic valve replacement may improve outcomes in patients with preoperative mild-to-moderate aortic regurgitation remains unclear.
A retrospective propensity score-matched analysis of adult patients with preoperative mild-to-moderate aortic regurgitation undergoing durable LVAD implantation between 01/01/2011 and 30/11/2021 was performed. Patients undergoing concomitant valve surgery other than biological aortic valve replacement were excluded, resulting in 77 with concomitant biological aortic valve replacement and 385 without.
Following 1:1 propensity score matching, two groups of 55 patients with and without biological aortic valve replacement were obtained, (mean age 59 ± 11 years, 92% male, 59.1% HeartWare). Aortic regurgitation was mild in 72.7% and 76.4% and moderate in 27.3% and 23.6% in non-replacement and replacement cohorts respectively. The 30-day survival was 89.1% vs. 85.5% (p = 0.59), 1-year survival 69.1% vs. 56.4% (p = 0.19), and 2-year survival 61.8% vs. 47.3% (p = 0.10) in the non-replacement and replacement groups, respectively. After a mean follow-up of 1.2 years, non-replacement patients had a higher incidence of pump thrombosis (11 [20%] vs. 3 [5.5%], p = 0.022) and fewer major bleedings (2 [3.6%] vs. 11 [20%], p = 0.008).
Compared with those treated conservatively, patients with mild-to-moderate aortic regurgitation undergoing concomitant aortic valve replacement during LVAD implantation have a similar survival up to 2 years on support. Patients with concomitant valve replacement had a higher risk of bleeding complications but fewer pump thromboses.
左心室辅助装置（LVAD）治疗可能导致主动脉瓣反流，限制左心室减负并引发不良事件。术前轻至中度主动脉瓣反流患者同期行主动脉瓣置换术是否能改善预后仍不明确。
对2011年1月1日至2021年11月30日期间接受持久LVAD植入术的术前轻至中度主动脉瓣反流成年患者进行回顾性倾向评分匹配分析。排除同期接受除生物主动脉瓣置换术以外的瓣膜手术的患者，最终纳入77例同期行生物主动脉瓣置换术的患者和385例未行该手术的患者。
经过1:1倾向评分匹配，得到两组各55例患者，分别为行和未行生物主动脉瓣置换术的患者（平均年龄59±11岁，男性占92%，使用HeartWare的患者占59.1%）。在未置换组和置换组中，主动脉瓣反流轻度分别占72.7%和76.4%，中度分别占27.3%和23.6%。未置换组和置换组的30天生存率分别为89.1%和85.5%（p = 0.59），1年生存率分别为69.1%和56.4%（p = 0.19），2年生存率分别为61.8%和47.3%（p = 0.10）。平均随访1.2年后，未置换组患者泵血栓形成的发生率更高（11例[20%]对3例[5.5%]，p = 0.022），严重出血事件更少（2例[3.6%]对11例[20%]，p = 0.008）。
与保守治疗的患者相比，在LVAD植入期间同期行主动脉瓣置换术的轻至中度主动脉瓣反流患者在接受支持治疗的2年内生存率相似。同期行瓣膜置换术的患者出血并发症风险更高，但泵血栓形成较少。
