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Postimplant left ventricular assist device fit analysis using three-dimensional reconstruction.

Thang V Truong1, J Ryan Stanfield, John S Chaffin

  • 1From the *Nazhi Zudhi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma; †Department of Cardiothoracic Surgery, College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma; and ‡Department of Mechanical Engineering, University of Utah, Salt Lake City, Utah.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|November 1, 2013
PubMed
Summary

Optimal left ventricular assist device (LVAD) inflow cannula (IC) alignment is crucial for patient survival. This study reveals common surgical angles deviate from ideal mitral valve alignment, with specific deviations linked to increased mortality.

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Area of Science:

  • Cardiovascular Surgery
  • Biomedical Engineering
  • Medical Imaging

Background:

  • Left ventricular assist devices (LVADs) improve survival in heart failure by augmenting cardiac function.
  • Effective LVAD performance requires unobstructed inflow cannula (IC) alignment with the mitral valve (MV).
  • Current surgical practices for IC placement may not consistently achieve optimal alignment.

Purpose of the Study:

  • To quantify inflow cannula (IC) orientation deviation from ideal mitral valve (MV) alignment in patients with left ventricular assist devices (LVADs).
  • To compare common surgical IC angulation with angles for direct IC-MV alignment.
  • To identify the association between IC deviation and patient mortality.

Main Methods:

  • Creation of 3D anatomic models from computed tomography scans of 24 LVAD-implanted patients.
  • Measurement of IC angles in coronal and sagittal planes relative to the apical z-axis.
  • Analysis of deviation from hypothesized conventional and direct IC-MV alignment angles.

Main Results:

  • Common surgical IC angulation averaged 22° rightward and 21° posterior; only 38% of patients achieved this.
  • Ideal direct IC-MV alignment averaged 34° rightward and 15° posterior; only 8% of patients achieved this.
  • Rightward and anterior IC deviations were associated with increased mortality.

Conclusions:

  • Current surgical IC angulation often deviates from optimal MV alignment.
  • Preoperative anatomic modeling can aid in achieving patient-specific optimal IC alignment for LVAD implantation.
  • Optimizing IC alignment may improve LVAD outcomes and reduce mortality.