Association of Aortic Root and Valve Morphology With De Novo Aortic Valve Regurgitation After Implantation of Left Ventricular Assist Device.

Background: The development of aortic valve regurgitation (AR) negatively affects the survival of patients with continuous-flow left ventricular assist device (LVAD) support. Although several risk factors have been identified, little is known about the effect of preoperative aortic root and valve morphology on the development of de novo AR after LVAD implantation.

Methods: Between April 2018 and September 2023, 87 patients underwent durable LVAD implantation at our department. Of these, the 15 eligible patients who underwent preoperative electrocardiography-synchronized cardiac contrast-enhanced computed tomography were included in this study. Baseline aortic root and valve morphology and its relationship with the postoperative development of AR were retrospectively reviewed.

Results: The mean duration of LVAD support was 1208 ± 618 days. At 60 months postsurgery, 10 patients had mild or greater AR (Group I) and the others did not (Group N). The measurement of baseline aortic root morphology showed that the ratio of virtual basal ring diameter to geometric height (VBD/GH) was significantly larger for Group I (1.70 ± 0.024 vs. 1.48 ± 0.034; p = 0.0001).

Conclusions: A large preoperative VBD/GH is a significant risk factor for de novo AR. This finding may assist in determining the surgical indications for concomitant aortic valve procedures with durable LVAD implantation.