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Aortic Root Thrombosis in Patients with HeartMate 3 Left Ventricular Assist Device Support.

Aortic Root Thrombosis in Patients with HeartMate 3 Left Ventricular Assist Device Support. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Carey, M. R., Marshall, D., Clerkin, K., Laracuente, R., Sanchez, J., Jain, S. S., Raikhelkar, J. K., Leb, J. S., Kaku, Y., Yuzefpolskaya, M., Naka, Y., Colombo, P. C., Sayer, G. T., Takeda, K., Uriel, N., Topkara, V. K., Fried, J. A. 2023

Abstract

BACKGROUND: Aortic root thrombus (ART) formation is a complication of continuous flow left ventricular assist device (LVAD) therapy. However, the incidence and related complications of ART in HeartMate 3 (HM3) patients remains unknown.METHODS: Patients who underwent HM3 implantation from November 2014 through August 2020 at a quaternary academic medical center were included. Demographics and outcomes were abstracted from the medical record. Echocardiograms and contrast-enhanced CT studies were reviewed to identify patients who developed ART and/or moderate or greater aortic insufficiency (AI) on HM3 support.RESULTS: The study cohort included 197 HM3 patients with a median post-implant follow-up of 17.5 months. Nineteen patients (9.6%) developed ART during HM3 support, and 15 patients (7.6%) developed moderate or greater AI. Baseline age, gender, race, implantation strategy, and INTERMACS classification were similar between the ART and no-ART groups. ART was associated with an increased risk of death, stroke, or AV intervention (subhazard ratio [SHR] 3.60 [95% CI 1.71-7.56]; p=0.001) and moderate or greater AI (SHR 11.1 [CI 3.60-34.1]; p<0.001) but was not associated with a statistically significantly increased risk of death or stroke on HM3 support (2.12 [0.86-5.22]; p=0.10). Of the 19 patients with ART, 6 (31.6%) developed moderate or greater AI, necessitating more frequent AV interventions (ART: 5 AV interventions [3 surgical repairs, 1 surgical replacement, 1 transcatheter replacement; 26.3%]; no-ART: 0).CONCLUSION: Nearly 10% of HM3 patients developed ART during device support. ART was associated with increased risk of a composite endpoint of death, stroke, or AV intervention as well as moderate or greater AI.

View details for DOI 10.1016/j.healun.2023.08.023

View details for PubMedID 37739242