The Journal of Heart and Lung Transplantation
Volume 29, Issue 12 , Pages 1321-1329 , December 2010

Aortic valve pathophysiology during left ventricular assist device support

  • Ranjit John, MD

      Affiliations

    • Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
    • Corresponding Author InformationReprint requests: Ranjit John, MD, Division of Cardiothoracic Surgery, University of Minnesota Minneapolis, MN 55455. Telephone: 612-626-3664. Fax: 612-625-1683
  • ,
  • Katie Mantz, BS

      Affiliations

    • Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
  • ,
  • Peter Eckman, MD

      Affiliations

    • Department of Medicine, University of Minnesota, Minneapolis, Minnesota
  • ,
  • Alan Rose, MD

      Affiliations

    • Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
  • ,
  • Karen May-Newman, PhD

      Affiliations

    • Bioengineering Program, Department of Mechanical Engineering, San Diego State University, San Diego

References 

  1. Frazier OH, Rose EA, Oz MC, et al. Multicenter clinical evaluation of the HeartMate vented electric left ventricular assist system in patients awaiting heart transplantation. J Thorac Cardiovasc Surg. 2001;122:1186–1195
  2. Deng MC, Edwards LB, Hertz MI, et al. International Society for Heart and Lung Transplantation Mechanical circulatory support device database of the International Society for Heart and Lung Transplantation: third annual report—2005. J Heart Lung Transplant. 2005;24:1182
  3. Morgan JA, John R, Rao V, et al. Bridging to transplant with the HeartMate left ventricular assist device: The Columbia Presbyterian 12-year experience. J Thorac Cardiovasc Surg. 2004;127:1309–1316
  4. Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med. 2001;345:1435–1443
  5. Rao V, Slater J, Edwards N, et al. Surgical management of valvular disease in patients requiring left ventricular assist device support. Ann Thorac Surg. 2001;71:1448–1453
  6. Zamarripa Garcia MA, Enriquez LA, Dembitsky W, May-Newman K. The effect of aortic valve incompetence on the hemodynamics of a continuous flow ventricular assist device in a mock circulation. ASAIO J. 2008;54:237–244
  7. Travis AR, Giridharan GA, Pantalos GM, et al. Vascular pulsatility in patients with a pulsatile or continuous flow ventricular assist device. J Thorac Cardiovasc Surg. 2007;133:517–524
  8. Robiscek F. Leonardo da Vinci and the sinuses of Valsalva. Ann Thorac Surg. 1991;52:328–335
  9. Yoganathan AP, He Z, Jones SC. Fluid mechanics of heart valves. Ann Rev Biomed Eng. 2004;6:331–362
  10. Thubrikaar MJ. The aortic valve. Boca Raton, FL: CRC Press; 1990;
  11. Dagum P, Green GR, Nistal FJ, et al. Deformational dynamics of the aortic root: modes and physiological determinants. Circulation. 1999;100:II54–II62
  12. Gundiah N, Kam K, Mathews PB, et al. Asymmetric mechanical properties of porcine aortic sinuses. Ann Thor Surg. 2008;85:1631–1638
  13. Robiscek F, Thubrikar MJ. Role of sinus wall compliance in aortic leaflet function. Am J Card. 1999;84:944–946
  14. Furukawa K, Ohteki H, Cao Z, et al. Does dilatation of the sinotubular junction cause aortic regurgitation?. Ann Thorac Surg. 1999;69:949–954
  15. Samuels LE, Thomas MP, Holmes EC, et al. Insufficiency of the native aortic valve and left ventricular assist system inflow valve after support with an implantable left ventricular assist system: signs, symptoms and concerns. J Thorac Cardiovasc Surg. 2001;122:380–381
  16. Bryant A, Holman W, Nanda N, et al. Native aortic valve insufficiency in patients with ventricular assist devices. Ann Thorac Surg. 2006;81;e 6–8
  17. Park SJ, Liao KK, Segurola R, Madhu KP, Miller LW. Management of aortic insufficiency in patients with left ventricular assist devices: a simple coaptation stitch method (Park's stitch). J Thorac Cardiovasc Surg. 2004;127:264–266
  18. Horton SC, Khodaverdia R, Powers A, et al. Left ventricular assist device malfunction: a systematic approach to diagnosis. J Am Coll Cardiol. 2004;43:1574–1583
  19. Feldman C, Silver M, Sobieski M, Slaughter M. Management of aortic insufficiency with continuous flow left ventricular assist devices: bioprosthetic valve replacement. J Heart Lung Transplant. 2006;1410–1412
  20. Barbone A, Rao V, Oz MC, Naka N. LVAD support in patients with bioprosthetic valves. Ann Thorac Surg. 2002;74:232–234
  21. Rose AG, Connelly JH, Park SJ, Frazier OH, Miller LW, Ormaza S. Total left ventricular outflow tract obstruction due to left ventricular device-induced sub-aortic thrombosis in 2 patients with aortic valve bioprosthesis. J Heart Lung Transplant. 2003;22:594–599
  22. Pal JD, Klodell CT, John R, et al. Low operative mortality with implantation of a continuous-flow left ventricular assist device and impact of concurrent procedures. Circulation. 2009;120:S215–S219
  23. Butany J, Leong SW, Rao V, et al. Early changes in bioprosthetic heart valves following ventricular assist device implantation. Int J Cardiol. 2007;117:20–23
  24. Miller LW, Pagani FD, Russell SD, et al. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 2007;357:885–896
  25. John R, Kamdar F, Liao K, et al. Improved survival and decreasing incidence of adverse events using the HeartMate II left ventricular assist device as a bridge-to-transplant. Ann Thorac Surg. 2008;86:1227–1235
  26. Tisol WB, Mueller DK, Hoy FB, Gomez RC, Clemson BS, Hussain SM. Ventricular assist device use with mechanical heart valves: an outcome series and literature review. Ann Thorac Surg. 2001;72:2051–2055
  27. Swartz MT, Lowdermilk GA, Moroney DA, McBride LR. Ventricular assist device support in patients with mechanical heart valves. Ann Thorac Surg. 1999;68:2248–2251
  28. Savage EB, d'Amato TA, Magovern JA. Aortic valve patch closure; an alternative to replacement with HeartMate LVAS insertion. Eur J Cardiothorac Surg. 1999;16:359–361
  29. Stingham JC, Bull DA, Karwande SV. Patch closure of the aortic annulus in a recipient of a ventricular assist device. J Thorac Cardiovasc Surg. 2000;119:1293–1294
  30. Tasset MR, Kavarana MN, Gray LA, Dowling RD. Simple mechanical aortic valve closure in ventricular assist device recipients. Ann Thorac Surg. 2006;82:316–318
  31. Rose A, Park S, Bank A, Miller L. Partial aortic valve fusion induced by left ventricular assist device. Ann Thorac Surg. 2000;70:1270–1274
  32. Connelly J, Abrams J, Klima T, et al. Acquired commissural fusion of aortic valves in patients with left ventricular assist devices. J Heart Lung Transplant. 2003;22:1291–1295
  33. Letsou G, Connelly J, Delgado R, et al. Is native aortic valve commissural fusions in patients with long-term left ventricular assist devices associated with clinically important aortic insufficiency?. J Heart Lung Transplant. 2006;25:395–399
  34. Rose AG, Park SJ. Pathology in patients with ventricular assist devices (A study of 21 autopsies, 24 ventricular apical core biopsies and 24 explanted hearts). Cardiovasc Path. 2005;14:19–23
  35. Banchs JE, Dawn B, Abdel-Latif A, et al. Acquired aortic cusp fusion after chronic left ventricular assist device support. J Am Soc Echo. 2006;19:1401
  36. Baradarian S, Dembitsky W, Jaski B, et al. Left ventricular outflow tract obstruction associated with chronic ventricular assist device support. ASAIO J. 2002;48:665–667
  37. Nishimura M, Ohtake S, Sawa Y, et al. Severe aortic valve fusion after nearly three years of support with the Novacor left ventricular assist system. J Thorac Cardiovasc Surg. 2002;124:179–180
  38. Mudd JO, Cuda JD, Halushka M, Soderlund KA, Conte JV, Russell SD. Fusion of aortic valve commissures in patients supported by a continuous axial flow ventricular assist device. J Heart Lung Transplant. 2008;27:1269–1274
  39. Hayashi K. Biomechanical studies of the remodeling of knee joint tendons and ligaments. J Biomech. 1996;29:707–716
  40. Mann BK, Schmedlen RH, West JL. Tethered-TGF-beta increases extracelleular matrix production of vascular smooth muscle cells. Biomaterials. 2001;22:439–444
  41. Streuli C. Extracellular matrix remodelling and cellular differentiation. Curr Opin Cell Biol. 1999;11:634–640
  42. Fung YC. Biomechanics (Motion, flow, stress and growth). New York: Springer-Verlag; 1990;
  43. Beck A, Thubrikar M, Robicsek F. Stress analysis of the aortic valve with and without the sinuses of Valsalva. J Heart Valve Dis. 2001;10:1–11
  44. Boerboom RA, Driessen NJB, Bouten CVC, Huyghe JM, Baaijens FPT. Finite element model of mechanically induced collagen fiber synthesis and degradation in the aortic valve. Ann Biomed Eng. 2003;31:1040–1053
  45. Butcher JT, Simmons CA, Warnock JN. Mechanobiology of the aortic heart valve. J Heart Valve Dis. 2008;17:62–73
  46. Balachandran K, Sucosky P, Jo H, Yoganathan AP. Elevated cyclic stretch alters matrix remodeling in aortic valve cusps: implications for degenerative aortic valve disease. Am J Physiol Heart Circ Physiol. 2009;296:H756–H764
  47. Xing Y, Warnock J, He Z, Hilbert SL, Yoganathan AP. Cyclic pressure affects the biological properties of porcine aortic valve leaflets in a magnitude and frequency dependent manner. Ann Biomed Eng. 2004;32:1461–1470
  48. El-Hamamsy I, Balachandran K, Yacoub MH, et al. Endothelium-dependent regulation of the mechanical properties of aortic valve cusps. J Am Coll Cardiol. 2009;53:1448–1455
  49. Gudi SR, Lee AA, Clark CB, Frangos JA. Equibiaxial strain and strain rate stimulate early activation of G proteins in cardiac fibroblasts. Am J Physiol. 1998;274:C1424–C1428
  50. Lee AA, Delhaas T, McCulloch AD, Villarreal FJ. Differential responses of adult cardiac fibroblasts to in vitro biaxial strain patterns. J Mol Cell Cardiol. 1999;31:1833–1843
  51. Atance J, Yost MJ, Carver W. Influence of the extracellular matrix on the regulation of cardiac fibroblast behavior by mechanical stretch. J Cell Physiol. 2004;200:377–386
  52. May-Newman K, Hillen B, Dembitsky W. Effect of left ventricular assist device outflow conduit anastomosis location on flow patterns in the native aorta. ASAIO J. 2006;52:132–139
  53. Nishimura T, Tatsumi E, Takaichi S, et al. Prolonged nonpulsatile left heart bypass with reduced systemic pulse pressure causes morphological changes in the aortic wall. Artif Organs. 1998;22:405–410
  54. Westaby S, Bertoni GB, Clelland C, Nishinaka T, Frazier OH. Circulatory support with attenuated pulse pressure alters human aortic wall morphology. J Thorac Cardiovasc Surg. 2007;133:573–577
  55. Maybaum S, Mancini D, Xydas S, et al. Cardiac improvement during mechanical circulatory support: a prospective multicenter study of the LVAD working group. Circulation. 2007;115:2497–2505
  56. Maybaum S, Epstein S, Beniaminovitz A, et al. Partial loading of the left ventricle during mechanical assist device support is associated with improved myocardial function, blood flow and metabolism and increased exercise capacity. J Heart Lung Transplant. 2002;21:446–4
  57. Tuzun E, Gregoric J, Conger K, et al. The effect of intermittent low speed mode upon aortic valve opening in calves supported with a Jarvik 2000 axial flow device. ASAIO J. 2005;51:139–4
  58. Khodanerdian RA, Mason NO, Horton SC, et al. Aortic valve/root thrombosis with continuous flow devices. J Heart Lung Transplant. 2008;27:S132–S133
  59. John R, Kamdar F, Liao K, et al. Low thromboembolic risk with the HeartMate II left ventricular assist device. J Thorac Cardiovasc Surg. 2008;136:1318–1323
  60. Scalia GM, McCarthy PM, Savage RM, et al. Clinical utility of echocardiography in the management of implantable ventricular assist devices. J Am Soc Echo. 2000;13:754–763
  61. Chumnanvej S, Wood MJ, MacGillivray TE, Melo MF. Perioperative echocardiographic examination for ventricular assist device implantation. Anesth Analg. 2008;105:583–601

PII: S1053-2498(10)00367-0

doi: 10.1016/j.healun.2010.06.006

The Journal of Heart and Lung Transplantation
Volume 29, Issue 12 , Pages 1321-1329 , December 2010