ADULT: MECHANICAL CIRCULATORY SUPPORT

Objective: The study objective was to investigate the progression of uncorrected mild aortic insufficiency and its impact on survival and functional status after left ventricular assist device implantation. Methods: We retrospectively reviewed 694 consecutive patients who underwent implantation of a continuous-flow left ventricular assist device between January 2006 and March 2018. Pre–left ventricular assist device transthoracic echocardiography identified 111 patients with mild aortic insufficiency and 493 patients with trace or no aortic insufficiency. To adjust for differences in preoperative factors, propensity score matching was used, resulting in 101 matched patients in each of the mild aortic insufficiency and no aortic insufficiency groups. Results: Although both groups showed similar survival (P 1⁄4 .58), the mild aortic insufficiency group experienced higher incidence of readmission caused by heart failure (hazard ratio, 2.62; 95% confidence interval, 1.42-4.69; P< .01). By using the mixed effect model, pre–left ventricular assist device mild aortic insufficiency was a significant risk factor for both moderate or greater aortic insufficiency and worsening New York Heart Association functional status (P< .01). Conclusions: Patients with uncorrected mild aortic insufficiency had a higher risk of progression to moderate or greater aortic insufficiency after left ventricular assist device implantation with worse functional status and higher incidence of readmission caused by heart failure compared with patients without aortic insufficiency. Further investigations into the safety and efficacy of concomitant aortic valve procedures for mild aortic insufficiency at the time of left ventricular assist device implant are warranted to improve patients’ quality of life, considering the longer left ventricular assist device use as destination therapy and bridge to transplant with the new US heart allocation system. (J Thorac Cardiovasc Surg 2020;160:1490-500) From the Division of Cardiothoracic Surgery, Department of Surgery, and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, Mo. Institutional Review Board approval number and date: #201409140; 12/17/2018. Read at the 99th Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, May 4-7, 2019. Received for publication May 8, 2019; revisions received Feb 25, 2020; accepted for publication Feb 27, 2020; available ahead of print May 12, 2020. Address for reprints: Akinobu Itoh, MD, PhD, Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Campus Box 8234, 660 Euclid Ave, St. Louis, MO 63110 (E-mail: itoha@wustl.edu). 0022-5223 Copyright 2020 The Author(s). Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). https://doi.org/10.1016/j.jtcvs. 2020.02. 144 Scanning t you to the access sup tion. To vie Meeting W next to the 1490 The Journal of Thoracic and Cardiovascular Surgery c December 0 4 5 0 40