Impact of aortic geometry and outflow graft angle on aortic insufficiency in pediatric LVAD patients

OBJECTIVE: Left ventricular assist devices (LVADs) are a essential therapy option for children with end-stage heart failure, aiming to prolong survival and enhance quality of life during the wait for heart transplantation. This study evaluated the impact of aortic geometry and outflow graft angle on the development of aortic insufficiency (AI) following LVAD implantation in pediatric patients. METHODS: This retrospective study included 22 pediatric patients under the age of 18 who underwent isolated LVAD implantation between 2014 and 2024. Aortic geometry, outflow graft angles, and aortic valve function were assessed using echocardiography and computed tomography. The development of postoperative AI was monitored over a 1-year period using a validated grading system from the literature. Patients were categorized into two groups based on AI severity; AI < 1 (none or trivial) and AI ⩾1 (mild or greater). RESULTS: The mean age was 12.1 years and 77.3% of the patients were male. Median survival, as estimated by Kaplan-Meier analysis, was 1.555 days. At 12 months, 40.9% of patients had developed mild AI. A significant negative correlation was found between AI and aortic root diameter, sinotubular junction (STJ) diameter and proximal ascending aortic diameter. ROC analysis identified an aortic root diameter of ⩽22.1 mm as a threshold predictive of AI. CONCLUSION: Long-term LVAD support appears to be a safe and effective strategy in pediatric patients. The overall risk of AI was low and the effect of outflow graft angle on complications was limited. Aortic root diameter may serve as an important predictor of AI development. In this population, developing surgical technique and device positioning to individual anatomical characteristics may improve clinical outcomes.