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The Fate of the Aortic Root following Implantation of Continuous Flow Left Ventricular Assist Device
Sung Ho Jung, John M Stulak, Jin-Oh Choi, Lyle D Joyce, Richard C Daly.
Mayo Clinic, Rochester, MN, USA.

OBJECTIVE: The present study was performed to know whether the aortic root size increase or not during the left ventricular assist device (LVAD) support, so to confirm that the increase of aortic root size might contribute to the development of aortic regurgitation after LVAD implantation.
METHODS: Between February 2007 and December 2012, 212 patients underwent LVAD implantation. We only included the continuous flow type LVAD and excluded the patients with pulsatile LVAD, pre-implant aortic valve pathology more than mild, previous or concomitant aortic valve surgery, post implant surgery including the aortic valve or transplantation before 2 years postoperatively surgery, and less than 2 years follow up duration. We examined the degree of aortic valve regurgitation and echocardiographic measurements of the aortic valve annulus, aortic root and sinotubular junction in patients immediately post implant and after 2 years of LVAD support.
RESULTS: There were 43 patients who met criteria and in whom measurements were obtained. The median degree of aortic regurgitation increased from trivial immediately post implant to mild at 2 years. Median aortic valve annulus size (cm) remained stable (2.34 vs. 2.32, p=0.55), as did the sinuses of Valsalva (3.49 vs. 3.47, p=0.85) and cephalad to the sinotubular junction (2.93 vs. 2.97, p=0.89).
CONCLUSIONS: We confirm the observation that aortic valve regurgitation progresses following long-term support with a continuous flow LVAD. The mechanism does not appear to be due to aortic annular and aortic root dilatation as we observe that the size of these structures remain stable after prolonged support.

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