Clinical management of aortic valve regurgitation after left ventricular assist device implantation: prediction, assessment, and treatment strategies

Left ventricular assist devices (LVADs) have become a core treatment modality for end-stage heart failure. However, aortic regurgitation (AR) remains a common postoperative complication that significantly threatens patient outcomes. This narrative review examines the pathophysiological mechanisms, predictive factors, assessment methods, and intervention strategies for AR following LVAD implantation, aiming to provide guidance for clinical practice. Studies have shown that preoperative age ≥60 years, female gender, lower body surface area, mild AR, proximal ascending aorta diameter/body surface area > 15.5 mm/m², and higher cumulative dose of beta-blockers increase the risk of AR. Postoperative aortic valve opening restriction and prolonged LVAD support time are strong predictors of significant AR. Among device types, axial flow pumps have a higher incidence of AR than fully magnetic levitation centrifugal pumps; Traditional assessment methods have limited applicability and should be combined with hemodynamic characteristics (such as central venous pressure, pulmonary capillary wedge pressure, and pulmonary artery pulsatility index) and multimodal imaging techniques such as transthoracic echocardiography (AR width/LVOT width ratio), transesophageal echocardiography, and cardiac magnetic resonance imaging; Preoperative repair or replacement of moderate or severe AR can reduce postoperative risks, and transcatheter aortic valve replacement (TAVR) is the preferred treatment for significant AR postoperatively. Future efforts should focus on optimizing the assessment system and improving device design to enhance long-term patient outcomes.