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Examining Hearts Containing Left Ventricular Assist Devices at Necropsy
William C Roberts1, Nuvaira Ather2, Joseph M Guileyardo3
1Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
Left ventricular assist device (LVAD) cannula misalignment within the heart is common. This necropsy study found frequent deviations from optimal LVAD cannula placement, potentially impacting function.
Area of Science:
- Cardiovascular Surgery
- Medical Device Research
- Pathology
Background:
- Left ventricular assist devices (LVADs) are crucial for end-stage heart failure treatment.
- Optimal LVAD cannula placement is essential for device efficacy and patient outcomes.
- Limited necropsy data exists on LVAD cannula positioning within the left ventricle.
Purpose of the Study:
- To investigate the relationship between the LVAD cannula and the left ventricular (LV) cavity and wall.
- To identify patterns of LVAD cannula insertion and potential misalignments in post-mortem hearts.
Main Methods:
- Necropsy examination of 15 adult hearts with prior LVAD implantation.
- Analysis of LVAD cannula insertion angle, location (apex, anterior, posterior walls), and contact with the LV endocardium.
- Correlation of findings with duration of LVAD support.
Main Results:
- The LVAD cannula was inserted at an angle to the LV longitudinal axis in 13 of 15 patients.
- The cannula orifice margin contacted the LV wall in 11 patients.
- Cannula insertion into the LV apex was common (11 patients), but often not aligned with the LV cavity's longitudinal axis (9 patients).
Conclusions:
- Misalignment of LVAD cannulas within the left ventricle is a frequent finding in necropsy studies.
- Factors such as epicardial adipose tissue and pericardial adhesions may hinder proper cannula alignment during surgery.
- While some misalignments may have minimal physiologic impact, others could potentially affect cannula flow dynamics.
