INTRODUCTION: Left ventricular assist device (LVAD) therapy may lead to an aortic regurgitation, limiting left ventricular unloading and causing adverse events. Whether concomitant aortic valve replacement may improve outcomes in patients with preoperative mild-to-moderate aortic regurgitation remains unclear. METHODS: A retrospective propensity score-matched analysis of adult patients with preoperative mild-to-moderate aortic regurgitation undergoing durable LVAD implantation between 01/01/2011 and 30/11/2021 was performed. Patients undergoing concomitant valve surgery other than biological aortic valve replacement were excluded, resulting in 77 with concomitant biological aortic valve replacement and 385 without. RESULTS: Following 1:1 propensity score matching, two groups of 55 patients with and without biological aortic valve replacement were obtained, (mean age 59 ± 11 years, 92% male, 59.1% HeartWare). Aortic regurgitation was mild in 72.7% and 76.4% and moderate in 27.3% and 23.6% in non-replacement and replacement cohorts respectively. The 30-day survival was 89.1% vs. 85.5% (p = 0.59), 1-year survival 69.1% vs. 56.4% (p = 0.19), and 2-year survival 61.8% vs. 47.3% (p = 0.10) in the non-replacement and replacement groups, respectively. After a mean follow-up of 1.2 years, non-replacement patients had a higher incidence of pump thrombosis (11 [20%] vs. 3 [5.5%], p = 0.022) and fewer major bleedings (2 [3.6%] vs. 11 [20%], p = 0.008). CONCLUSION: Compared with those treated conservatively, patients with mild-to-moderate aortic regurgitation undergoing concomitant aortic valve replacement during LVAD implantation have a similar survival up to 2 years on support. Patients with concomitant valve replacement had a higher risk of bleeding complications but fewer pump thromboses.

Cardiac Surgery Unit Cardiothoracic Department University Hospital of Udine Udine Italy

City of Health and Science Hospital Turin Department of Surgical Sciences University of Turin Turin Italy

Department of Cardiac Surgery University Hospital Leuven Leuven Belgium

Department of Cardiothoracic and Vascular Surgery Deutsches Herzzentrum der Charité Berlin Germany

Department of Cardiothoracic Surgery Jena University Hospital Friedrich Schiller University Jena Germany

Department of Cardiothoracic Surgery Medical University of Vienna Vienna Austria

Department of Cardiovascular Surgery Charité Universitätsmedizin Berlin Berlin Germany

Department of Cardiovascular Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Health Sciences and Technology ETH Zurich Zürich Switzerland

Department of Medical and Surgical Sciences Alma Mater Studiorum University of Bologna Bologna Italy

Department of Thoracic Cardiac and Vascular Surgery Heart and Diabetes Centre Bad Oeynhausen Germany

DZHK Partner Site Berlin Berlin Germany

EUROMACS Registry EACTS Windsor UK

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