Pathophysiology and Management of Valvular Lesions in the Setting of LVAD Support

About this Research Topic

Background

Durable left ventricular assist device (LVAD) technology is advancing at a rapid pace with increasing reliability of mechanical circulatory support for progressively longer periods. With more patients living longer on their LVAD as destination therapy or until eventual heart transplantation, concomitant valvular disease will have a greater impact on outcomes and patient quality of life. While some valvular lesions exist prior to LVAD implantation, others develop de novo from continuous flow mechanical support physiology. The presence of valvular disease in the setting of LVAD support is known to reduce effective cardiac output, increase left ventricular and atrial pressure, and increase right ventricular afterload. These hemodynamic changes can in turn contribute to right heart failure and negatively impact patient outcomes.

Since current and future LVAD therapy is expected to last for a longer duration, understanding the clinical implications, outcomes and treatment strategies for associated valve disease is now of greater urgency. In aortic valve insufficiency, there are a number of considerations including timing of intervention and selection of appropriate procedures such as the Park Stitch, aortic valve repair as well as open and transcatheter aortic valve replacements. Similarly, there is recent data that helps us to identify patients who might benefit from mitral valve interventions such as mitral annuloplasty, Alfieri stitch or transcatheter mitral procedures. Furthermore, the use of tricuspid valve repair or replacement to improve right ventricular output has been rigorously examined recently. We will also determine the impact of valve lesions on right heart function. The use of computer hemodynamic modelling of valve lesions will also be explored as an important tool to determine impact of valve lesion on hemodynamics after LVAD implant.

This Research Topic series aims to provide a state of the art overview of our current understanding and the management of valvular disease in the setting of durable LVAD support. This collection will bring together authors who are experts in the field of mechanical circulatory support and/or interventions for valvular heart disease.

Review articles on the following topics by authors will be featured in this collection:
1) Aortic insufficiency in LVAD setting - pathophysiology and consequences.
2) Mitral regurgitation in LVAD setting - pathophysiology and consequences.
3) Computational assessment of valvular hemodynamics during LVAD.
4) Surgical intervention for aortic regurgitation in LVAD patients - open surgical techniques and outcomes.
5) Transcatheter valvular therapies in patients with LVAD.
6) Tricuspid regurgitation in LVAD setting - pathophysiology and management.
7) Impact of valve pathology on RV function in the LVAD setting.
8) Surgical intervention for mitral regurgitation in LVAD patients – open surgical techniques and outcomes.
9) Progression and outcome of valve pathology in destination LVAD patients.
10) Impact of valve lesions in LVAD patients with congenital heart disease.

Furthermore, outside of the above stated review articles which will anchor the topic series, the submission of any relevant original research would be very welcome.

Keywords: Heart failure, Left ventricular assist device (LVAD), Valve regurgitation, Mitral valve, Aortic valve, Tricuspid valve, Right heart failure

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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