March 2016 – Abstract 2

Abstract by Dr. Hartmuth Bittner
Presented at the Heart Valve Society’s annual scientific meeting in New York City.

Percutaneous Closure of the Insufficient Aortic Valve in a Heart Failure Patient on a Left Ventricular Assist Device Patient

Objective:
Aortic insufficiency (AI) is increasingly recognized as a complication of continuous flow left ventricular assist device (CF-LVAD) support and may lead to clinical decompensation requiring correction. The incidence of “de novo” AI in patients supported with the CF-LVAD Heartmate II (Thoratec Corp., Pleasanton, CA) is greater than 25%.

Methods and Results:
In this case report, we present a patient status post Heartmate II implantation as a third time redo sternotomy for ischemic cardiomyopathy complicated by de novo aortic insufficiency. He underwent coronary bypass surgery in 2002 with redo surgical revascularization in 2010. At 11 months post-implant, this 74 year old hard working architect presented with severe right and left heart failure, multi-organ dysfunction, and hepato-renal failure. Multiple echocardiograms revealed an opening aortic valve and near normal right ventricular function in the past. Six weeks ago, when the worsening AI was diagnosed, the decrease of Heartmate II CF-LVAD flow through decreasing the rounds per minute (RPM) from 8800 RPM to 8200 RPM attenuated the AI markedly. Ultimately, the patient underwent percutaneous, transcatheter closure of the aortic valve (see echo and heart catheter images and video) with a multi-fenestrated 30 mm Amplatzer Cribiform closure device (AGA Medical Corp., Plymouth, MN). Under echocardiography the flow of the CF-LVAD was increased to 9400 RPM. Two weeks post procedure, the patient remains stable with improved symptoms and functional status, and without evidence of further aortic insufficiency or device migration.

Conclusion:
Percutaneous transcatheter closure of the aortic valve effectively treats LVAD-associated AI and reduces pulmonary capillary wedge pressure. This procedure should be considered to treat LVAD-associated AI in patients who are poor candidates for repeat operation and catheter-based aortic valve procedures.