Abstract 20215: Left Ventricular Assist Device Inflow Cannula-Mitral Alignment and Pump Migration Impact LVAD Dysfunction Over Long Term Support
Purpose: LVAD position at implant has long term implications with aligning the inflow cannula along the mitral valve axis and anchoring the pump as important goals. This study investigates the impact of LVAD inflow cannula-mitral alignment, inflow cannula angle, and pump migration on pump dysfunction/failure in HeartMate II (HM2) patients.
Methods: Patients (n=311) who received primary HM2 LVADs from 1/1/2008-12/31/2013 at a single institution were retrospectively reviewed. Patients who underwent pump exchange for pump thrombus/dysfunction (PD, n=21) and patients without pump dysfunction (NL, n=290) were compared. The inflow cannula -LVAD body angle (IL angle) were measured by chest x-ray post operatively, before discharge and at follow up. Mitral alignment was assessed by axial and coronal angles between LVAD inflow cannula and mitral valve planes on CT Scan. Pump migration was defined as difference between IL angle between discharge and follow up. Echocardiograms and LVAD settings were reviewed.
Results: Follow up periods were 15.8±15.0 months (PD) and 14.2±12.7 months (NL). There were no differences in age, INTERMACS profile, preoperative LV IDD or discharge LVAD settings in each group. There were significant differences in IL angle between NL and PD at all time points. On CT, the PD group had more acute inflow cannula coronal angulation (septal deviation). Echocardiography revealed significantly less left ventricular decompression in PD at discharge and follow up. (Table).
Conclusions: In this HM2 cohort, acute angulation and pump migration was associated with pump dysfunction and LVAD exchange. Acute coronal angulation with the mitral axis was importantly associated with LVAD dysfunction. Early postoperative dysfunction, as evidenced by a lack of LV decompression, was associated with future need for exchange/transplant. This study is the first to demonstrate the importance of mitral inflow alignment and the implications of early dysfunction in LVADs.
Author Disclosures: T. Kazui: None. A. Bierhals: None. A. Zhang: None. J. Greenberg: None. A.D. Keith: None. A. Itoh: None. G.A. Ewald: Research Grant; Modest; Thoratec. Consultant/Advisory Board; Modest; Heartware, Thoratec. S.C. Silvestry: Consultant/Advisory Board; Modest; Heartware. Consultant/Advisory Board; Significant; Thoratec.
- © 2014 by American Heart Association, Inc.