Does postoperative blood pressure influence development of aortic regurgitation following continuous flow left ventricular assist device implantation?
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.
European journal of cardio thoracic surgery official journal of the European Association for Cardio thoracic Surgery