Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec;38(12):2771-2779.
doi: 10.1007/s10554-022-02683-z. Epub 2022 Jul 19.

Left ventricular assist device and pump thrombosis: the importance of the inflow cannula position

Kirsten A Kortekaas #  1 , Michiel A de Graaf #  2 , Meindert Palmen  3 , Jerry Braun  3 , Bart J A Mertens  4 , Laurens F Tops  2 , Saskia L M A Beeres  2
Affiliations

Left ventricular assist device and pump thrombosis: the importance of the inflow cannula position

Kirsten A Kortekaas et al. Int J Cardiovasc Imaging. 2022 Dec.

Abstract

Pump thrombosis is a devastating complication after left ventricular assist device implantation. This study aims to elucidate the relation between left ventricular assist device implantation angle and risk of pump thrombosis. Between November 2010 and March 2020, 53 left ventricular assist device-patients underwent a computed tomography scan. Using a 3-dimensional multiplanar reformation the left ventricular axis was reconstructed to measure the implantation angle of the inflow cannula. All patients were retrospectively analyzed for the occurrence of pump thrombosis. In 10 (91%) patients with a pump thrombosis, the implantation angle was towards the lateral wall of the left ventricle. In only 20 patients (49%) of the patients without a pump thrombosis the inflow cannula pointed towards the lateral wall of the left ventricle. The mean angle in patients with a pump thrombosis was 10.1 ± 11.9 degrees towards the lateral wall of the left ventricle compared to 4.1 ± 19.9 degrees towards the septum in non-pump thrombosis patients (P = 0.005). There was a trend towards a significant difference in time to first pump thrombosis between patients with a lateral or septal deviated left ventricular assist device (hazard ratio of 0.15, P = 0.07). This study demonstrates that left ventricular assist device implantation angle is associated with pump thrombosis. Almost all patients in whom a pump thrombosis occurred during follow-up had a left ventricular assist device implanted with the inflow-cannula pointing towards the lateral wall of the left ventricle.

Keywords: CT based angle measurement; Left ventricular assist device; Pump thrombosis.

PubMed Disclaimer

Conflict of interest statement

There is no conflict of interest for the present manuscript.

Figures

Fig. 1
Fig. 1
Example of Computed Tomography measurements. Computed tomography data were used to measure the implantation angle of the inflow cannula of the LVAD. Using a 3-dimensional MPR the LV long axis was reconstructed. A On a transversal plane, the MPR crosshair is aligned with the mitral valve annulus and the perpendicular part of the crosshair parallel to the LV long-axis. B This is repeated in the sagittal view to create a double oblique short-axis view of the LV. C The crosshair is further aligned to the septum to create a double oblique four-chamber and two-chamber view, with the crosshair parallel to the LV long-axis. (D + E) By adjusting the window settings the angle between the inflow cannula of the LVAD and the LV-axis can be visualized in the two-chamber (D; anterior or inferior) and four-chamber (E; septal or lateral) view. LV left ventricle, LVAD left ventricular assist device, MPR multiplanar reformation, PT pump thrombosis
Fig. 2
Fig. 2
Bland–Altman analysis and correlation plots. a Bland–Altman and correlation plots showing inter-observer agreement for CT measurements in all subjects (n = 53). On the four-chamber view a negative value represents an angle towards the lateral wall of the LV. On the two-chamber view a negative value represents an angle towards inferior. b Bland–Altman and correlation plots showing intra-observer agreement for CT measurements in all subjects (n = 53)
Fig. 3
Fig. 3
Mean implantation angle. Boxplot graph demonstrating the relation between PT and implantation angle. Overall, 42% of the patients had an LVAD implanted towards the LV septum and 58% towards the lateral wall of the LV. In patients with a pump thrombosis 91% had an implantation angle towards the lateral wall of the LV compared to 49% of the non-pump thrombosis (non-PT) patients. On the two-chamber view the LVAD implantation angle was towards inferior in the majority of patients (94%). None of the patients with a pump thrombosis had an implantation angle towards anterior. LVAD left ventricular assist device, PT pump thrombosis
Fig. 4
Fig. 4
Relation between two- and four-chamber view implantation angle. This scatter diagram shows the relation between the implantation angle on the four- (X axis) and two- (Y axis) chamber view in relation to the occurrence of left ventricular assist device pump thrombosis. Of note, the majority of patients with a pump thrombosis had an implantation angle towards the inferolateral wall of the LV. LV left ventricle
See this image and copyright information in PMC

References

    1. Michaels A, Cowger J. Patient selection for destination LVAD therapy: predicting success in the short and long term. Curr Heart Fail Rep. 2019;16(5):140–149. doi: 10.1007/s11897-019-00434-1. - DOI - PubMed
    1. Bhama JK, Bansal A. Left ventricular assist device inflow cannula position may contribute to the development of HeartMate II left ventricular assist device pump thrombosis. Ochsner J. 2018;18(2):131–135. doi: 10.31486/toj.17.0070. - DOI - PMC - PubMed
    1. Fraser KH, Taskin ME, Griffith BP, Wu ZJ. The use of computational fluid dynamics in the development of ventricular assist devices. Med Eng Phys. 2011;33(3):263–280. doi: 10.1016/j.medengphy.2010.10.014. - DOI - PMC - PubMed
    1. Laumen M, Kaufmann T, Timms D, Schlanstein P, Jansen S, Gregory S, et al. Flow analysis of ventricular assist device inflow and outflow cannula positioning using a naturally shaped ventricle and aortic branch. Artif Organs. 2010;34(10):798–806. doi: 10.1111/j.1525-1594.2010.01098.x. - DOI - PubMed
    1. Ong C, Dokos S, Chan B, Lim E, Al Abed A, Bin Abu Osman NA, et al. Numerical investigation of the effect of cannula placement on thrombosis. Theor Biol Med Model. 2013;10:35. doi: 10.1186/1742-4682-10-35. - DOI - PMC - PubMed