C-39 | Impact of Interhospital Transfer and Hospital Characteristics on Outcomes in Thoracic Aortic Dissection: A National Analysis

Background: Aortic regurgitation (AR) is a known complication of left ventricular assist devices (LVADs), and it is often noted with heart failure decompensation and LVAD recirculation.While the surgical aortic valve replacement (SAVR) is a high-risk procedure among the patient population, transcatheter aortic valve replacement (TAVR) has been a viable alternative.This study analyses the results and methods of the TAVR patient population with LVAD-related aortic regurgitation.Methods: A PubMed, Embase, and Cochrane database search was conducted to identify the available clinical data for the use of TAVR in AR in adult patients with the use of durable LVAD.A total of eight studies fulfilled the inclusion criteria, which included six clinical series and two national registry analyses.Results: Eight studies were identified for analysis, with a total of 149 patients who underwent TAVR for AR with LVAD support (HeartMate II, HeartMate 3, and HVAD).Procedure success was 100% using AR transcatheter valves or anchoring strategies.However, the use of TAVR devices for AR resulted in a 37.5% incidence of a second TAVR due to device migration or paravalvular leak.In-hospital mortality was 3.7% in the largest series but ranged from 29% to 67% in smaller high-acuity groups.One-year survival ranged from 25% to 75%, with the majority of deaths due to non-valvular causes such as septic shock and LVAD thrombosis.Survivors demonstrated improved AR severity, functional class, and right ventricular function.Also, in the registry analysis including 87 patients who underwent TAVR versus 61 patients who underwent SAVR, significantly lower incidences of cardiogenic shock, major bleeding, and ventilation on arrival, along with shorter hospital stay (13.8 versus 40.0 days), were found with TAVR.Conclusions: TAVR is a viable treatment option for symptomatic AR in patients with durable LVAD support, providing meaningful clinical improvement.Procedural success is optimized with dedicated AR devices or advanced anchoring strategies, whereas off-label use is limited by migration risk.While TAVR offers lower perioperative morbidity than SAVR, substantial long-term mortality highlights the need for prospective multicenter studies.