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. 2019 May/Jun;65(4):331-335.
doi: 10.1097/MAT.0000000000000823.

Association of Inflow Cannula Position with Left Ventricular Unloading and Clinical Outcomes in Patients with HeartMate II Left Ventricular Assist Device

Teruhiko Imamura  1 , Ann Nguyen  1 , Ben Chung  1 , Daniel Rodgers  1 , Nitasha Sarswat  1 , Gene Kim  1 , Jayant Raikhelkar  1 , Sirtaz Adatya  1 , Takeyoshi Ota  1 , Tae Song  1 , Colleen Juricek  2 , Jerry D Estep  3 , Daniel Burkhoff  4 , Valluvan Jeevanandam  2 , Gabriel Sayer  1 , Nir Uriel  1
Affiliations

Association of Inflow Cannula Position with Left Ventricular Unloading and Clinical Outcomes in Patients with HeartMate II Left Ventricular Assist Device

Teruhiko Imamura et al. ASAIO J. 2019 May/Jun.

Abstract

The relationship between the HeartMate II left ventricular assist device (LVAD) position and pump thrombosis has been reported. However, further clinical implications of device position are unknown. This study aimed to investigate optimal device position for better left ventricular (LV) unloading and patient prognosis. Patients undergoing a ramp test with right heart catheterization after HeartMate II LVAD implantation were enrolled to this study. Device position was quantified from the chest X-ray obtained at the time of the ramp test: (1) inflow cannula angle relative to horizontal line, (2) pump angle relative to spine, (3) pump depth, (4) angle between inflow cannula and pump, and (5) angle between pump and outflow graft. LV unloading was assessed by pulmonary capillary wedge pressure at set LVAD speed. Fifty-four patients (60 years old and 34 male [63%]) were enrolled. Nobody experienced device malfunction during the study period. Increased LV unloading (i.e., lower pulmonary capillary wedge pressure) was associated with a narrower inflow cannula angle relative to horizontal line. Inflow cannula angle <75° was associated with higher 1 year heart failure readmission-free survival rate (p < 0.05, hazards ratio 7.56 [95% confidence interval 2.32-24.7]). In conclusion, HeartMate II LVAD inflow cannula position was associated with LV unloading and patient prognosis. Prospective studies to ensure optimal device positioning and target better clinical outcomes are warranted.

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Figures

Figure 1.
Figure 1.
Device position parameters measured. A, Inflow cannula angle; B, pump angle relative to spine; C, pump depth; D, angle between inflow cannula and pump; and E, angle between pump and outflow graft.
Figure 2.
Figure 2.
Distributions of device position parameters.
Figure 3.
Figure 3.
Pulmonary capillary wedge pressure (PCWP) stratified by the cutoff of inflow cannula angle (75°). *p < 0.05 by Mann–Whitney U test.
Figure 4.
Figure 4.
Heart failure (HF) readmission-free survival rate stratified by the cutoff of inflow cannula angle (75°). *p < 0.05 by log-rank test.
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