Management of Aortic Insufficiency Using Transcatheter Aortic Valve Replacement in Patients with Left Ventricular Assist Device Support

Abstract

Left ventricular assist devices (LVADs) increase survival of patients with heart failure. However, long-term LVAD usage can result in aortic insufficiency (AI), thereby compromising LVAD efficiency. Transcatheter aortic valve replacement (TAVR) is an alternative for patients with high risk for surgical valve replacement. We present three cases that developed moderate to severe AI while on HeartMate II (Abbott Laboratories, Chicago, IL) LVAD support; hence, TAVR procedure was performed. Patients A and B (74 year old and 38 year old) developed severe AI and patient C (67 year old) developed moderate AI with cardiogenic shock, after 368, 1,288, and 342 days on LVAD support, respectively. Their aortic valve annulus sizes were 24.2, 24.6, and 23.3 mm, respectively. Oversized Edwards SAPIEN 3 valves (Edwards, Lifesciences, Irvine, CA) were implanted via a transfemoral approach. The patients were hemodynamically stable after the procedure with mild AI in patient A and no AI in patients B and C. Patients were all discharged to home. Follow-up in patients A and C have resulted in long-term (> 2 years) survival and patient B died 616 days after the procedure due to unrelated complications. Transcatheter aortic valve replacement may be an alternative way to manage AI in LVAD patients. Larger studies are needed to evaluate the long-term efficacy of this approach.