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Review
. 2022 Jul;37(7):2086-2089.
doi: 10.1111/jocs.16547. Epub 2022 Apr 26.

Concomitant aortic valve repair for aortic insufficiency and implantation of left ventricle mechanical support

Arun K Singhal  1 , Jarrod Bang  2 , Anthony L Panos  1 , Andrew Feider  2 , Satoshi Hanada  2 , J Scott Rankin  3
Affiliations
Review

Concomitant aortic valve repair for aortic insufficiency and implantation of left ventricle mechanical support

Arun K Singhal et al. J Card Surg. 2022 Jul.

Abstract

Background: Moderate to severe aortic valve insufficiency (AI) in patients undergoing left ventricular assist device (LVAD) implantation is a significant complication which occurs in up to 10.7% of patients in the INTERMACS database and has profound consequences for survival. Preoperative Impella use is associaed with greater post-LVAD AI.

Case presentation: 56 y/o Caucasian female with acute exacerbation of chronic congestive heart failure who needed urgent Impella placement followed by elective Heartmate III LVAD.

Conclusion: Patients who have aortic valve regurgitation at the time of implantation have been handled by several methods, including aortic valve leaflets approximation, to aortic valve replacement or even valve closure. We report a case of geometric ring annuloplasty for repair of a regurgitant aortic valve during destination LVAD implantation.

Keywords: HAART Ring; LVAD; aortic valve regurgitation; aortic valve repair; complications; heart failure; nonischemic cardiomyopathy.

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Conflict of interest statement

Dr. Rankin is a consultant for BioStable Science and Engineering, Austin TX.

Figures

Figure 1
Figure 1
(A) Precardiopulmonary bypass, mid‐esophageal aortic valve short axis view with Impella in place crossing the aortic valve between the noncoronary and right coronary cusps. (B) On cardiopulmonary bypass following removal of Impella device, mid‐esophageal aortic valve short axis with color flow doppler demonstrating two AI Jets, one central and one at the location of the removed Impella. (C) On cardiopulmonary bypass following removal of Impella catheter, mid‐esophageal aortic valve long axis view demonstrating the central aortic insufficiency jet. (D) Postcardiopulmonary bypass and aortic valve repair, mid‐esophageal aortic valve long axis view demonstrating trace aortic insufficiency through a central jet
Figure 2
Figure 2
(A) Aortic annuloplasty ring (HAART 300—trileaflet aortic valve). (B) Illustration of aortic annuloplasty ring in the sub valvular position. (C) Aortic valve postrepair with aortic annuloplasty ring
See this image and copyright information in PMC

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