Impact of Concomitant Aortic Valve Replacement in Patients with Mild-to-Moderate Aortic Valve Regurgitation Undergoing LVAD Implantation: Propensity Score-Matched Analysis of the EUROMACS Dataset

Purpose: Aortic valve regurgitation (AR) may be observed in patients undergoing left ventricular assist device (LVAD) implantation. AR in LVAD recipients leads to a persistent heart failure scenario. In this study we compared the outcomes of LVAD patients with preoperative mild-to- moderate AR who underwent a concomitant aortic valve replacement (AVR) to those in whom AR was left untreated. Methods: A retrospective propensity score-matched analysis of adult pa- tients enrolled in the EUROMACS registry between January 2011 and December 2021 was performed. Patients with mild-to-moderate AR were divided into two groups: with and without concomitant biological AVR. Patients, who underwent aortic valve repair or mechanical AVR were excluded from the analysis. Results: Following 1:1 propensity score matching, each group consisted of 55 patients. The mean age was 59 ± 11 years, 101 (92%) were male, 67 (61%) were on inotropic support, and 30 (27.3%) on temporary mechanical circulatory support. Eighty-two (74.5%) patients presented mild and 28 (25.5%) moderate AR. AVR patients demonstrated longer duration of invasive ventilation (353 ± 526 min vs. 133 ± 272 min, p=0.017), but si- milar incidence of postoperative reintubation and dialysis. Patients in non- AVR cohort had a higher incidence of pump thrombosis (11 (20%) vs. 3 (5.5%), p=0.022) but less major bleeding events (9 (16.4%) vs. 18 (32.7%), p=0.046). The 30-day mortality was 10.9% vs. 14.5% (p=0.59) in non-AVR and AVR group, respectively. One-year mortality was 30.9 % vs. 43.6% (p=0.19), 3-year mortality 41.8% and 58.2% (p=0.1), and 5-year mortality (47.3% and 63.6% (p=0.1), respectively. There was no difference in the incidence of heart transplantation (7 (12.7%) vs. 9 (16.4%), p=0.59) and LVAD weaning (2 (3.6%) vs. 5 (9.1%), p=0.22) between the non- AVR and AVR group, respectively. Conclusion: Patients with mild-to-moderate AR undergoing concomitant AVR during LVAD implantation have similar survival compared to those without AVR. Patients with concomitant AVR observed a higher risk of bleeding complications but had less pump thrombosis events.