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- Title
Does postoperative blood pressure influence development of aortic regurgitation following continuous-flow left ventricular assist device implantation?
- Authors
Patila, Nikhil Prakash; Mohite, Prashant Nanasaheb; Sabashnikov, Anton; Dhar, Dhruva; Weymann, Alexander; Zeriouh, Mohamed; Koch, Achim; Garcia-Saez, Diana; Zych, Bartlomiej; Hards, Rachel; Hedger, Michael; De Robertis, Fabio; Moza, Ajay; Bahrami, Toufan; Amrani, Mohamed; Rahman-Haley, Shelley; Popov, Aron Frederik; Banner, Nicholas; Simon, André Rudiger
- Abstract
OBJECTIVES: The true impact of postoperative blood pressure (BP) control on development of aortic regurgitation (AR) following continuous-flow left ventricular assist device (CF-LVAD) implantation remains uncertain. This study examines the influence of BP in patients with de novo AR following CF-LVAD implantation. METHODS: All patients with no or <mild AR who underwent CF-LVAD implantation from July 2006 to July 2012 at our institute and with subsequent device-support of ≥3months (n = 90) were studied. Serial echocardiograms and BP readings were obtained preoperatively, postoperatively at 1, 3 and 6 months, and then at a minimum of 4-monthly intervals. BP readings were compared between patients who developed mild AR (AR group) versus those who did not (non-AR group). Logistic regression analysis was used to define independent predictors of ≥mild AR following CF-LVAD implantation. RESULTS: Median duration of CF-LVAD support was 575 days (range: 98-2433 days). Forty-eight patients (53.3%) developed mild AR over a median duration of 126 days. BP readings (median values, mmHg) between AR and non-AR groups showed statistically significant differences: at 3 months--systolic 99.5 vs 92.5 (P = 0.038), diastolic 81.5 vs 66 (P < 0.001), mean 86.5 vs 74 (P < 0.001) and at 6 months--diastolic 73 vs 62 (P = 0.044), mean 83 vs 74.5 (P = 0.049), respectively. Systolic BP at 3 months (P = 0.047, 95% CI 0.453-0.994, OR 0.671), aortic valve (AoV) closure (P = 0.01, 95% CI 0.002-0.429, OR 0.029) and duration of support (P = 0.04, 95% CI 1.000-1.009, OR 1.004) were found to be independent predictors of AR following CF-LVAD implantation. CONCLUSIONS: BP readings at 3 months and 6 months showed a statistically significant association with =mild AR following CF-LVAD implantation, with systolic blood pressure at 3 months, aortic valve closure and longer support duration being independent predictors. Clinical implications of these data may warrant consideration of aggressive early control of BP to protect against the development/progress of AR following CF-LVAD implantation.
- Subjects
SYSTOLIC blood pressure; ECHOCARDIOGRAPHY; AORTIC valve insufficiency; HYPERTENSION; TRANSPLANTATION of organs, tissues, etc.
- Publication
European Journal of Cardio-Thoracic Surgery, 2016, Vol 49, Issue 3, p788
- ISSN
1010-7940
- Publication type
Article
- DOI
10.1093/ejcts/ezv221