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

## TL;DR

This study finds that a specific aortic root measurement before LVAD implantation is linked to new aortic valve regurgitation after surgery.

## Contribution

Identifies a novel preoperative morphological risk factor for post-LVAD aortic valve regurgitation.

## Key findings

- Patients with higher VBD/GH ratios had significantly more postoperative aortic regurgitation.
- A VBD/GH ratio above 1.6 may indicate higher risk for new aortic valve insufficiency after LVAD implantation.

## Abstract

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.

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.

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).

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.

Large preoperative aortic virtual basal ring diameter to geometric height ratio may be a novel risk factor for de novo aortic insufficiency after durable LVAD implantation and assist in determining surgical indications for concomitant aortic valve procedures with LVAD implantation.