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Updated: Feb 13, 2026
In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
Role of computed tomography angiography for HeartMate II left ventricular assist device thrombosis
Sarah N Yu1, Jiho Han1, Koji Takeda1
11 Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA.
Insights
Computed tomography angiography helps identify anatomical issues causing HeartMate II left ventricular assist device thrombosis. This imaging can guide surgical decisions for device thrombosis, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Biomedical Engineering
Background:
- Device thrombosis is a critical complication for HeartMate II left ventricular assist devices.
- Accurate assessment of anatomical factors is crucial for managing device thrombosis.
Purpose of the Study:
- To evaluate computed tomography angiography (CTA) for assessing anatomical properties related to HeartMate II left ventricular assist device thrombosis.
- To determine the impact of CTA findings on clinical management and patient outcomes.
Main Methods:
- Retrospective analysis of 22 patients with suspected HeartMate II device thrombosis undergoing CTA.
- Assessment of outflow graft (contrast filling defect) and inflow cannula (space at inflow, M-I angle) using CTA.
- Evaluation of inflow abnormalities using chest X-ray (inflow angulation, pump pocket depth).
Main Results:
- CTA identified outflow graft defects in 14% of patients, altering surgical approach.
- Inflow graft malpositioning was observed in four patients, obstructing the cannula.
- CTA provided quantitative measurements of inflow space and M-I angle, alongside X-ray derived inflow angle and pump pocket depth.
Conclusions:
- Computed tomography angiography offers a noninvasive method to assess outflow grafts and inflow cannulas in left ventricular assist device patients.
- CTA findings can reveal mechanical causes of thrombosis and inform surgical management strategies.
- This imaging modality aids in optimizing treatment for device thrombosis.
Introduction:
Device thrombosis is one of the most devastating complications of HeartMate II left ventricular assist devices. The purpose of this study is to assess the anatomical properties that the inflow and outflow computed tomography angiography provides in assessing for left ventricular assist device thrombosis, as well as their impact on clinical management and postoperative outcomes.
Methods:
Between April 2010 and December 2016, 22 patients who received a HeartMate II left ventricular assist device implantation were readmitted for suspected device thrombosis and underwent a computed tomography angiography for workup. Left ventricular assist device-associated anatomy was assessed, including outflow abnormality on computed tomography angiography (contrast filling defect), inflow abnormalities on computed tomography angiography (space at inflow, M-I angle), and inflow abnormalities on chest X-ray (inflow angulation, pump pocket depth).
Results:
Computed tomography angiography revealed an outflow filling defect in three patients (14%) resulting in change in surgical approach from subcostal pump exchange to resternotomy pump and outflow graft exchange. Inflow graft malpositioning was identified in four patients, with the inflow abutting the left ventricular wall and obstructing the cannula opening. On computed tomography angiography assessment, mean space at inflow was 5.3 ± 1.6 mL and M-I angle was 35.6° ± 6.6°. Chest X-ray evaluation revealed mean inflow angle and pump pocket depth of 75.7° ± 13.4° and 110.2 ± 26.6 mm, respectively.
Conclusion:
Computed tomography angiography provides a noninvasive assessment of the outflow graft and inflow cannulas in left ventricular assist device patients. Findings on computed tomography angiography reveal possible mechanical etiologies of thrombosis and may be useful for determining the surgical management of device thrombosis patients.
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