The development of aortic insufficiency (AI) during HeartMate 3 durable left ventricular assist device (dLVAD) support can lead to ineffective pump output and recurrent heart failure symptoms. Progression of AI often comingles with the occurrence of other hemodynamic-related events encountered during LVAD support, including right heart failure, arrhythmias, and cardiorenal syndrome. While data on AI burdens and clinical impact are still insufficient in patients on HeartMate 3 support, moderate or worse AI occurs in approximately 8% of patients by 1 year and studies suggest AI continues to progress over time and is associated with increased frequency of right heart failure. The first line intervention for AI management is prevention, undertaking surgical intervention on the insufficient valve at the time of dLVAD implant and avoiding excessive device flows and hypertension during long-term support. Device speed augmentation may then be undertaken to try and overcome the insufficient lesion, but the progression of AI should be anticipated over the long term. Surgical or transcatheter aortic valve interventions may be considered in dLVAD patients with significant persistent AI despite medical management, but neither intervention is without risk. It is imperative that future studies of dLVAD support capture AI in clinical end-points using uniform assessment and grading of AI severity by individuals trained in AI assessment during dLVAD support.

中文翻译：

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接受现代耐用左心室辅助装置支持的患者主动脉功能不全：关于术前和术后评估和管理的最新综述。


在 HeartMate 3 耐用左心室辅助装置 （dLVAD） 支持期间，主动脉瓣功能不全 （AI） 的发展会导致泵输出无效和复发性心力衰竭症状。AI 的进展通常与 LVAD 支持期间遇到的其他血流动力学相关事件的发生混合，包括右心衰竭、心律失常和心肾综合征。虽然关于 HeartMate 3 支持的患者的 AI 负担和临床影响的数据仍然不足，但大约 8% 的患者在 1 年内会出现中度或更严重的 AI，研究表明 AI 会随着时间的推移继续进展，并且与右心衰竭的频率增加有关。AI 管理的一线干预是预防，在植入 dLVAD 时对瓣膜不足进行手术干预，并在长期支持期间避免过多的装置流量和高血压。然后可以进行设备速度增强以尝试克服不足的病变，但应长期预测 AI 的进展。对于尽管接受了药物治疗但仍有显著持续性 AI 的 dLVAD 患者，可以考虑手术或经导管主动脉瓣介入治疗，但这两种干预都并非没有风险。dLVAD 支持的未来研究必须通过在 dLVAD 支持期间接受 AI 评估培训的个人对 AI 严重性进行统一评估和分级，在临床终点捕获 AI。