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. 2018 Summer;18(2):131-135.
doi: 10.31486/toj.17.0070.

Left Ventricular Assist Device Inflow Cannula Position May Contribute to the Development of HeartMate II Left Ventricular Assist Device Pump Thrombosis

Jay K Bhama  1 , Aditya Bansal  2   3
Affiliations

Left Ventricular Assist Device Inflow Cannula Position May Contribute to the Development of HeartMate II Left Ventricular Assist Device Pump Thrombosis

Jay K Bhama et al. Ochsner J. 2018 Summer.

Abstract

Background: Pump thrombosis (PT) is a dreaded complication after left ventricular assist device (LVAD) implantation. Problems with inflow cannula (IC) position may precipitate thrombus development. We sought to determine if IC position contributes to the development of PT.

Methods: We conducted a retrospective review of 76 HeartMate II LVAD implants. The angle of the IC (AIC) to the horizontal plane was measured on chest x-rays. Patients who developed PT (PT group) were compared to the remaining patients (control group).

Results: The mean age at implantation was 56 ± 14 years, and 82% of the patients were male. Ten patients (13%) developed PT. Six (60%) required device exchange, and 4 (40%) were managed with anticoagulation and/or thrombolysis. The median AIC for all patients at implantation was 59° (range, 38°-98°; 25th-75th interquartile range, 50°-75°). In the PT group, the median AIC was larger at the time of PT diagnosis compared to implantation (70° vs 60°, P = 0.005). In the control group, the median AIC was also larger at follow-up compared to implantation (61° vs 58°, P < 0.001) although to a lesser degree than in the PT group. No difference was seen in the median AIC between the PT group and the control group at implantation (60° vs 58°, respectively; P = 0.668) or at follow-up (70° vs 61°, respectively; P = 0.309). However, the median AIC at follow-up in the PT group was significantly larger than the median AIC at implantation in the control group (70° vs 58°, respectively; P = 0.014).

Conclusion: The HeartMate II LVAD IC position contributes to the development of PT. Regular monitoring of cannula position may help identify patients at risk for this problem.

Keywords: Cannula; chest x-ray; thrombosis; ventricular assist device.

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Figures

Figure 1.
Figure 1.. The angle of the inflow cannula (AIC) as measured on routine chest x-ray demonstrates (A) a normal left ventricular assist device (LVAD) cannula position and angle and (B) an abnormal LVAD cannula position and angle in a patient who required device exchange.
Figure 2.
Figure 2.. Comparison of the median angle of the inflow cannula (AIC) for the entire cohort, the control group, and the pump thrombosis (PT) group.
aIntergroup (unpaired) comparison P values. bIntragroup (paired) comparison P values.
Figure 3.
Figure 3.. Box and whisker plots comparing the median angle of the inflow cannula (AIC) for the control group and the pump thrombosis (PT) group at implant and follow-up. For each group, the thick black line denotes the median, the upper and lower limits of the box denote the first and third quartile, and the bars denote maximum and minimum values.
See this image and copyright information in PMC

References

    1. Moazami N, Milano CA, John R et al. ; HeartMate II Investigators. Pump replacement for left ventricular assist device failure can be done safely and is associated with low mortality. Ann Thorac Surg. 2013. February;95(2):500-505. doi: 10.1016/j.athoracsur.2012.09.011. - DOI - PubMed
    1. Stulak JM, Cowger J, Haft JW, Romano MA, Aaronson KD, Pagani FD. Device exchange after primary left ventricular assist device implantation: indications and outcomes. Ann Thorac Surg. 2013. April;95(4):1262-1267; discussion 1267-1268. doi: 10.1016/j.athoracsur.2012.08.031. - DOI - PubMed
    1. Milano CA, Simeone AA, Blue LJ, Rogers JG. Presentation and management of left ventricular assist device inflow cannula malposition. J Heart Lung Transplant. 2011. July;30(7):838-840. doi: 10.1016/j.healun.2011.03.003. - DOI - PubMed
    1. Sorensen EN, Hiivala NJ, Jeudy J, Rajagopal K, Griffith BP. Computed tomography correlates of inflow cannula malposition in a continuous-flow ventricular-assist device. J Heart Lung Transplant. 2013. June;32(6):654-657. - PubMed
    1. Taghavi S, Ward C, Jayarajan SN, Gaughan J, Wilson LM, Mangi AA. Surgical technique influences HeartMate II left ventricular assist device thrombosis. Ann Thorac Surg. 2013. October;96(4):1259-1265. doi: 10.1016/j.athoracsur.2013.05.081. - DOI - PubMed

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