Value of transthoracic echocardiography to monitor and evaluate aortic insufficiency after implantation of left ventricular assist device_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHI Yisheng ¹ , ZHU Zhenhui ¹ ,  WANG Hao ¹ , DU Juan ² , CHEN Haibo ³ , HU Shengshou ³

1. Ultrasound Imaging Center, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;
2. Postoperative Recovery Center, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;
3. Adult Cardiac Surgery Center, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

WANG Hao, Email: hal6112@163.com

Keywords：

Transthoracic echocardiography; left ventricular assist device; aortic insufficiency

DOI：

10.7507/1007-4848.202102076

Video：

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Objective To explore the value of transthoracic echocardiography (TTE) to monitor and evaluate aortic insufficiency (AI) within one year after the implantation of the left ventricular assist device (LVAD).Methods We retrospectively collected and analyzed the TTE data of 12 patients who received LVAD implantation from 2018 to 2020 in our hospital. All patients were males, with an average age of 43.3±8.6 years. We analyzed temporal changes in the aortic annulus (AA), aortic sinus (AoS), ascending aorta (AAo), the severity of AI and the opening of aortic valve before operation and 1 month, 3 months, 6 months and 12 months after LVAD implantation.Results All 12 patients survived within 1 year after LVAD implantation. One patient was bridged to heart transplantation 6 months after implantation, and two patients did not receive TTE after 3 and 6 months. Compared to pre-implantation, AoS increased at 1 month after implantation (31.58±5.09 mm vs. 33.83±4.69 mm). The inner diameters of AA, AoS and AAo increased at 3, 6 and 12 months after LVAD implantation compared to pre-implantation (P<0.05), but all were within the normal range except for one patient whose AoS slightly increased before operation. After LVAD pump speed was adjusted, the opening of aortic valve improved. The severity of AI increased at 6 and 12 months after LVAD implantation compared to pre-implantation, and increased at 12 months compared to 6 months after LVAD implantation (P<0.05).Conclusion TTE can evaluate aortic regurgitation before and after LVAD implantation and monitor the optimization and adjustment of LVAD pump function, which has a positive impact on the prognosis after LVAD implantation.

Citation： SHI Yisheng, ZHU Zhenhui, WANG Hao, DU Juan, CHEN Haibo, HU Shengshou. Value of transthoracic echocardiography to monitor and evaluate aortic insufficiency after implantation of left ventricular assist device. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(6): 670-674. doi: 10.7507/1007-4848.202102076 Copy

1.	Noly PE, Pagani FD, Noiseux N, et al. Continuous-flow left ventricular assist devices and valvular heart disease: A comprehensive review. Can J Cardiol, 2020, 36(2): 244-260.
2.	Goodwin ML, Bobba CM, Mokadam NA, et al. Continuous-flow left ventricular assist devices and the aortic valve: Interactions, issues, and surgical therapy. Curr Heart Fail Rep, 2020, 17(4): 97-105.
3.	Kirklin JK, Pagani FD, Kormos RL, et al. Eighth annual INTERMACS report: Special focus on framing the impact of adverse events. J Heart Lung Transplant, 2017, 36(10): 1080-1086.
4.	中华医学会超声医学分会超声心动图学组. 中国成年人超声心动图检查测量指南. 中华超声影像学杂志, 2016, 25(8): 645-666.
5.	Kagawa H, Aranda-Michel E, Kormos RL, et al. Aortic insufficiency after left ventricular assist device implantation: Predictors and outcomes. Ann Thorac Surg, 2020, 110(3): 836-843.
6.	Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: A report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr, 2017, 30(4): 303-371.
7.	Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr, 2019, 32(1): 1-64.
8.	Stainback RF, Estep JD, Agler DA, et al. Echocardiography in the management of patients with left ventricular assist devices: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr, 2015, 28(8): 853-909.
9.	Yoshida S, Toda K, Miyagawa S, et al. Impact of turbulent blood flow in the aortic root on de novo aortic insufficiency during continuous-flow left ventricular-assist device support. Artif Organs, 2020, 44(8): 883-891.
10.	Tanaka Y, Nakajima T, Fischer I, et al. The impact of uncorrected mild aortic insufficiency at the time of left ventricular assist device implantation. J Thorac Cardiovasc Surg, 2020, 160(6): 1490-1500.
11.	da Rocha E Silva JG, Meyer AL, Eifert S, et al. Influence of aortic valve opening in patients with aortic insufficiency after left ventricular assist device implantation. Eur J Cardiothorac Surg, 2016, 49(3): 784-787.
12.	Bouabdallaoui N, El-Hamamsy I, Pham M, et al. Aortic regurgitation in patients with a left ventricular assist device: A contemporary review. J Heart Lung Transplant, 2018, 37(11): 1289-1297.
13.	Sujino Y, Kuroda K, Yoshitake K, et al. Clinical potential of hemodynamic ramp test by simultaneous echocardiography and right heart catheterization for aortic insufficiency in a patient with continuous-flow left ventricular assist device. J Artif Organs, 2020. [Epub ahead of print].
14.	Fang JC, Wever-Pinzon O. Dealing with unintended consequences: Continuous-flow lvads and aortic insufficiency. JACC Cardiovasc Imaging, 2016, 9(6): 652-654.
15.	Grinstein J, Kruse E, Sayer G, et al. Accurate quantification methods for aortic insufficiency severity in patients with LVAD: Role of diastolic flow acceleration and systolic-to-diastolic peak velocity ratio of outflow cannula. JACC Cardiovasc Imaging, 2016, 9(6): 641-651.

1. Noly PE, Pagani FD, Noiseux N, et al. Continuous-flow left ventricular assist devices and valvular heart disease: A comprehensive review. Can J Cardiol, 2020, 36(2): 244-260.
2. Goodwin ML, Bobba CM, Mokadam NA, et al. Continuous-flow left ventricular assist devices and the aortic valve: Interactions, issues, and surgical therapy. Curr Heart Fail Rep, 2020, 17(4): 97-105.
3. Kirklin JK, Pagani FD, Kormos RL, et al. Eighth annual INTERMACS report: Special focus on framing the impact of adverse events. J Heart Lung Transplant, 2017, 36(10): 1080-1086.
4. 中华医学会超声医学分会超声心动图学组. 中国成年人超声心动图检查测量指南. 中华超声影像学杂志, 2016, 25(8): 645-666.
5. Kagawa H, Aranda-Michel E, Kormos RL, et al. Aortic insufficiency after left ventricular assist device implantation: Predictors and outcomes. Ann Thorac Surg, 2020, 110(3): 836-843.
6. Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: A report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr, 2017, 30(4): 303-371.
7. Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr, 2019, 32(1): 1-64.
8. Stainback RF, Estep JD, Agler DA, et al. Echocardiography in the management of patients with left ventricular assist devices: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr, 2015, 28(8): 853-909.
9. Yoshida S, Toda K, Miyagawa S, et al. Impact of turbulent blood flow in the aortic root on de novo aortic insufficiency during continuous-flow left ventricular-assist device support. Artif Organs, 2020, 44(8): 883-891.
10. Tanaka Y, Nakajima T, Fischer I, et al. The impact of uncorrected mild aortic insufficiency at the time of left ventricular assist device implantation. J Thorac Cardiovasc Surg, 2020, 160(6): 1490-1500.
11. da Rocha E Silva JG, Meyer AL, Eifert S, et al. Influence of aortic valve opening in patients with aortic insufficiency after left ventricular assist device implantation. Eur J Cardiothorac Surg, 2016, 49(3): 784-787.
12. Bouabdallaoui N, El-Hamamsy I, Pham M, et al. Aortic regurgitation in patients with a left ventricular assist device: A contemporary review. J Heart Lung Transplant, 2018, 37(11): 1289-1297.
13. Sujino Y, Kuroda K, Yoshitake K, et al. Clinical potential of hemodynamic ramp test by simultaneous echocardiography and right heart catheterization for aortic insufficiency in a patient with continuous-flow left ventricular assist device. J Artif Organs, 2020. [Epub ahead of print].
14. Fang JC, Wever-Pinzon O. Dealing with unintended consequences: Continuous-flow lvads and aortic insufficiency. JACC Cardiovasc Imaging, 2016, 9(6): 652-654.
15. Grinstein J, Kruse E, Sayer G, et al. Accurate quantification methods for aortic insufficiency severity in patients with LVAD: Role of diastolic flow acceleration and systolic-to-diastolic peak velocity ratio of outflow cannula. JACC Cardiovasc Imaging, 2016, 9(6): 641-651.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Value of transthoracic echocardiography to monitor and evaluate aortic insufficiency after implantation of left ventricular assist device

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