Artif Organs. 2022 Jan 3. doi: 10.1111/aor.14165. Online ahead of print.
ABSTRACT
BACKGROUND: A relation between left ventricular assist device inflow cannula malposition and pump thrombus has been reported. This study aimed to investigate if the pump position, derived from chest X-rays in HeartMate 3 (HM3) patients, correlates with neurological dysfunction (ND), ischemic stroke (IS), hemorrhagic stroke (HS) and survival.
METHODS: This analysis was performed on routinely acquired X-rays of 42 patients implanted with a HM3 between 2014 and 2017. Device position was quantified in patients with and without ND from frontal and lateral X-rays characterizing the inflow cannula (IC) and pump in relation to spine, diaphragm or horizontal line. The primary end-point was freedom from stroke and survival one-year after HM3 implantation stratified by pump position.
RESULTS: The analysis of X-rays, 33.5 (41.0) days postoperative, revealed a significant smaller IC angle of HM3 patients with ND vs. no ND (0.1±14.0° vs. 12.9±10.1°, p=0.005). Additionally, the IC angle in the frontal view, IS: 4.1 (20.9)° vs. no IS: 13.8 (7.5)°, p=0.004 was significantly smaller for HM3 patients with IS. Using ROC derived cut-off, IC angle <10° provided 75% sensitivity and 100% specificity (C-statistic=0.85) for predicting IS. Stratified by IC angle, freedom from IS at 12 months was 100% (>10°) and 60% (<10°) respectively (p=0.002). No significant differences were found in any end-point between patients with and without HS. One-year survival was significantly higher in patients with IC angle >10° vs. <10° (100% vs. 71.8%, p=0.012).
CONCLUSIONS: Inflow cannula malposition derived from standard chest X-rays serves as a risk factor for neurological dysfunction, ischemic stroke and worse survival in HM3 patients.
PMID:34978722 | DOI:10.1111/aor.14165
