P45: Outcomes Of Percutaneous Transcatheter Interventions For Aortic Insufficiency In Patients With Continuous-Flow Left Ventricular Assist Devices: A Systematic Review

Background: De novo progressive aortic insufficiency (AI) in continuous-flow left ventricular assist devices (CF-LVADs) leads to impaired device performance and poor outcomes. Given the paucity of experience with transcatheter interventions for such AI, we sought to pool the existing evidence on patients treated with transcatheter interventions for de-novo AI following CF-LVAD use. Methods: Electronic search identified adult patients with CF-LVADs who underwent percutaneous transcatheter interventions for AI, including transcatheter aortic valve replacement (TAVR) or an occlusion device (OD) placement. Case-level data for 59 patients from 41 published reports and three unpublished cases were extracted and analyzed. Results: The median patient age was 61 years [Interquartile range (IQR) 52, 69] and 27% (16/59) were female. Non-ischemic cardiomyopathy was diagnosed in 45% (27/59) of patients. Following transcatheter intervention, median pre-intervention AI grade of 4 [4–4] improved to a median grade of 1 [0, 1] (p=<0.01). Both baseline and post-intervention AI grades were comparable between TAVR and OD. Valve-in-valve procedures were undertaken in 13.6 % (8/59) of patients due to paravalvular leak and valve dislodgement. With a median follow-up of 5.6 months [2.8, 8.5], the overall mortality was 32.2% (19/59) and was significantly less in the TAVR group [TAVR: 20.6% (7/34) vs. OD: 48% (12/25), p=0.04]. Kaplan-Meier survival analysis achieved no statistical significance in survival between the groups (Figure). Conclusions: Both TAVR and OD showed similar efficacy in reducing AI. Potentially greater overall mortality with OD warrants additional studies before their widespread utilization in this patient population.