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Safety and efficacy of aortic valvuloplasty for de novo aortic insufficiency in patients with a left-ventricular assist device

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Abstract

Objectives

Progression of aortic insufficiency during left-ventricular assist device (LVAD) support is a crucial topic. One treatment option is aortic valvuloplasty (AVP); however, there is controversy regarding its safety and efficacy. We investigated the safety and efficacy of AVP using the coaptation stitch method (Park’s stitch) performed for de novo aortic insufficiency.

Methods

Between 2013 and 2020, 175 consecutive patients underwent LVAD implantation, of which 7 patients [men, 2 (28.6%); median age, 55 years] underwent late-stage AVP. Two patients underwent AVP within 2 weeks, and the remaining six patients underwent AVP 3, 19, 24, 28, 42, and 49 months, respectively, after LVAD implantation.

Results

Preoperatively, the degree of aortic insufficiency was moderate in 6 (85.7%) patients and severe in 1 (14.3%) patient. AVP was technically successful in 6 (85.7%) patients, while one case of failed plasty was subsequently treated with bioprosthetic valve replacement. A 1-year post-AVP right heart catheterization study revealed a median pulmonary artery wedge pressure of 10.0 mmHg. No deaths or heart failure admissions occurred during the follow-up (median, 38.0 months). There was no aortic insufficiency in 2 (28.6%) patients; however, trivial AI was observed in 3 (42.8%) patients, and mild AI was observed in 1 (14.3%) patient 2 years postoperatively. However, at the 3-year follow-up, two patients developed an increase in AI grade from trivial to mild.

Conclusions

AVP using Park’s stitch was safe. It is critical to carefully observe the aortic valve during AVP surgery to ensure that AVP is appropriate.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Acknowledgements

The authors would like to thank Editage for editing a draft of this manuscript. The authors would also like to thank Jane Charbonneau, DVM, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Funding

This work was not supported by a specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Osaka, 564-8565, Japan

    Naoki Tadokoro, Satoshi Kainuma, Naonori Kawamoto, Takashi Kakuta, Kohei Tonai, Tomoyuki Fujita & Satsuki Fukushima

  2. Department of Cardiovascular Surgery, Keio University School of Medicine, Shinjuku-Ku, Tokyo, Japan

    Naoki Tadokoro & Hideyuki Shimizu

Authors
  1. Naoki Tadokoro
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  2. Satoshi Kainuma
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  3. Naonori Kawamoto
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  4. Takashi Kakuta
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  5. Kohei Tonai
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  6. Hideyuki Shimizu
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  7. Tomoyuki Fujita
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  8. Satsuki Fukushima
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Contributions

All authors contributed to the content of the article by designing the study; collecting, analyzing, and interpreting the data; and by participating in drafting and revising the manuscript. All authors approved the final version of the manuscript. All authors have agreed to submit this manuscript to this journal.

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Correspondence to Satsuki Fukushima.

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Tadokoro, N., Kainuma, S., Kawamoto, N. et al. Safety and efficacy of aortic valvuloplasty for de novo aortic insufficiency in patients with a left-ventricular assist device. Gen Thorac Cardiovasc Surg 72, 324–330 (2024). https://doi.org/10.1007/s11748-023-01974-z

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  • DOI: https://doi.org/10.1007/s11748-023-01974-z

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