Improved survival with concomitant surgery for aortic regurgitation during continuous-flow left ventricular assist device implantation.

OBJECTIVES: Despite the detrimental consequences associated with residual, progressive aortic regurgitation (AR) during LVAD support, correction of AR at LVAD implantation has rarely been shown to improve survival.

METHODS: A retrospective study was conducted using the Japanese registry database, which included 300 continuous-flow LVAD recipients with pre-existing AR (mild or greater). Patients were divided into two groups: those who underwent concomitant surgery for AR during LVAD implantation (n = 77) and those who did not (n = 223). The groups were compared for significant AR development, all-cause mortality, and readmission for adverse events. A propensity score-matched cohort was also created to allow comparison of these outcomes to those of patients with similar baseline.

RESULTS: The cumulative incidence of significant AR was lower after corrected AR than after uncorrected AR in both the pre-matched and matched analyses (p < 0.05). While mortality and readmission rates were similar between groups in the pre-matched cohort, mortality after uncorrected AR was higher in the matched cohort (p = 0.052). When the pre-matched cohort was divided by age, a trend towards improved survival (p = 0.099) was observed with correction compared to no correction in older patients (≥57 years), whereas the difference was negligible (p = 0.956) in younger patients (<57 years). These results were consistent in patients with mild AR at implantation, including the increased risk of significant AR for uncorrected AR (p = 0.058), as well as improved survival with AR correction in the older population (p = 0.054), but no survival difference in the younger population (p = 0.492).

CONCLUSIONS: In older patients, correction of pre-existing AR, including mild AR, may improve long-term survival after LVAD implantation.