Cannula and Pump Positions Are Associated With Left Ventricular Unloading and Clinical Outcome in Patients With HeartWare Left Ventricular Assist Device

JOURNAL OF CARDIAC FAILURE

卷:24

Article

Imamura, Teruhiko¹  Adatya, Sirtaz¹  Chung, Ben¹  Nguyen, Ann¹  Rodgers, Daniel¹  Sayer, Gabriel¹  Sarswat, Nitasha¹  Kim, Gene¹  Raikhelkar, Jayant¹  Ota, Takeyoshi²  Song, Tae²  Juricek, Colleen²  Medvedofsky, Diego¹  Jeevanandam, Valluvan²  Lang, Roberto¹  Estep, Jerry D.³  Burkhoff, Daniel⁴  Uriel, Nir¹ 

[1] Univ Chicago, Med Ctr, Dept Med, 5841 S Maryland Ave, Chicago, IL 60637 USA

[2] Univ Chicago, Med Ctr, Dept Surg, Chicago, IL 60637 USA

[3] Houston Methodist Hosp, Houston, TX USA

[4] Cardiovasc Res Fdn, New York, NY USA

关键词: Ramp;    hemodynamics;    HVAD;   

DOI  :  10.1016/j.cardfail.2017.09.013

来源: Elsevier

【 摘 要 】

Background: Cannula and pump positions are associated with clinical outcomes such as device thrombosis in patients with HeartMate II; however, clinical implications of HVAD (HeartWare International, Framingham, Massachusetts) cannula position are unknown. This study aims to assess the relationship among cannula position, left ventricular (LV) unloading, and patient prognosis. Methods and results: Twenty-seven HVAD patients (60.0 +/- 12.6 years of age and 19 males [70%]) underwent ramp test. Device position was quantified from chest X-ray parameters obtained at the time of the hemodyamic ramp test: (1) cannula coronal angle, (2) pump depth, (3) cannula sagittal angle, and (4) pump area. Lower cannula coronal angle was associated with LV unloading (as measured by smaller LV diastolic dimension and lower pulmonary capillary wedge pressure). Smaller pump area was associated with LV dynamic unloading, as assessed by steeper negative slopes of LV diastolic dimension and pulmonary capillary wedge pressure during incremental rotational speed change. Cannula coronal angle <= 65 degrees was associated with reduced heart failure readmission rate (hazard ratio, 10.33; P = .007 by log-rank test). Conclusion: HVAD cannula and pump positions are associated with LV unloading and improved clinical outcomes. Prospective studies evaluating surgical techniques to ensure optimal device positioning and its effects on clinical outcomes are warranted.

【 授权许可】

Free