Objectives: Approximately 15% of patients on left ventricular assist device (LVAD) support develop severe aortic regurgitation (AR). Since patients on LVAD support are considered at high risk for reoperation, the interventional approach is becoming increasingly important in this patient cohort.

Methods: We conducted a retrospective analysis to evaluate the outcomes of patients on LVAD support, who underwent transcatheter aortic valve implantation (TAVI) at our institution between January 1st, 2016 and December 1st, 2020.

Results: During the investigational period, 18 TAVI were performed in LVAD patients at our institution. Mean age was 62.4 (±9.6) years and 72.2% were male. Before LVAD implantation, no or mild AR was pre-existing. The time from LVAD implantation to severe AR ranged from 0.5 to 9.5 years.
17 (94.4%) interventions were performed via femoral access. In total 18 (78.3%) ballon-expandable valves and 5 (21.7%) self-expandable valves were implanted. Six (35.3%) patients showed trans-stent leak after valve implantation and were treated with valve-in-valve implantation. In five patients the implantation was performed during the same procedure, in one patient 69 days after index procedure. Overall, technical success according to the Valve Academic Research Consortium 3 (VARC-3) was achieved in 72,2% cases. 33.3% of patients were directly transferred from the recovery room to the normal ward; 50.0% of patients spent 1 or 2 days in the intensive care unit. The median length of hospital stay was 7.5 (4.5-20.75) days. Pre intervention, all patients presented with symptoms of HF of functional New York Heart Association class 3 or 4. After TAVI 77.8% of patients had no or only mild symptoms. In two patients minor vascular and access-related complications (as determined by VARC-3) occurred: one patient required endovascular stenting of the common femoral artery and the other conservative treatment of an arteriovenous fistula. Two patients suffered from third-degree atrioventricular block. One patient developed LVAD intrapump thrombosis. No patient suffered from VARC type ≥ 2 bleeding. Post-TAVI right heart failure with need for inotropic support was seen in three patients, of which one died within the hospital stay. Another patient died due to sepsis of unknown origin in an external hospital. This resulted in an all-cause mortality of 10.2% at 30 days.

Conclusion: TAVI is a safe and feasible way to treat severe aortic regurgitation in patients on LVAD support.