Continuous-Flow Left Ventricular Assist Devices and Valvular Heart Disease: A Comprehensive Review

Publication date: February 2020Source: Canadian Journal of Cardiology, Volume 36, Issue 2Author(s): Pierre-Emmanuel Noly, Francis D. Pagani, Nicolas Noiseux, John M. Stulak, Zain Khalpey, Michel Carrier, Simon MaltaisAbstractMechanical circulatory support with implantable durable continuous-flow left ventricular assist devices (CF-LVADs) represents an established surgical treatment option for patients with advanced heart failure refractory to guideline-directed medical therapy. CF-LVAD therapy has been demonstrated to offer significant survival, functional, and quality-of-life benefits. However, nearly one-half of patients with advanced heart failure undergoing implantation of a CF-LVAD have important valvular heart disease (VHD) present at the time of device implantation or develop VHD during support that can lead to worsening right or left ventricular dysfunction and result in development of recurrent heart failure, more frequent adverse events, and higher mortality. In this review, we summarize the recent evidence related to the pathophysiology and treatment of VHD in the setting of CF-LAVD support and include a review of the specific valve pathologies of aortic insufficiency (AI), mitral regurgitation (MR), and tricuspid regurgitation (TR). Recent data demonstrate an increasing appreciation and understanding of how VHD may adversely affect the hemodynamic benefits of CF-LVAD support. This is particularly relevant for MR, where increasing evidence now demonstrates that per...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research