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Updated: Nov 19, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Serial assessment of HeartMate 3 pump position and inflow angle and effects on adverse events
Hueyjong Shih1, Caley Butler1, Andrew Melehy1
1Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA.
Insights
Positional changes in the HeartMate 3 left ventricular assist device, particularly pump angle, are linked to adverse events. Monitoring device position is crucial for patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Biomedical Engineering
Background:
- Left ventricular assist devices (LVADs) are critical for end-stage heart failure.
- Optimizing LVAD placement is essential for device function and patient safety.
- The HeartMate 3 is a widely used continuous-flow LVAD.
Purpose of the Study:
- To analyze the positional changes of the HeartMate 3 LVAD using serial radiographs.
- To investigate the correlation between LVAD position and adverse events in recipients.
Main Methods:
- Retrospective analysis of 59 LVAD recipients with serial chest radiographs at 1, 6, and 12 months post-implantation.
- Measurement of pump angle, pump-spine distance, and pump-diaphragm depth.
- Recurrent event survival modeling to assess the relationship between position and a composite outcome (heart failure readmission, low flow alarms, stroke, or device occlusion).
Main Results:
- Significant changes in pump-spine distance and pump-diaphragm depth occurred between 1 and 6 months post-implantation.
- Larger pump angles at 1 month were associated with a composite outcome of adverse events (P=0.04).
- Changes in pump depth between 1-6 and 6-12 months showed a weak association with the composite outcome.
Conclusions:
- Increased pump angle is associated with position-related adverse events in HeartMate 3 LVAD recipients.
- Pump depth changes demonstrate a weak association with adverse outcomes.
- Radiographic monitoring of LVAD position may aid in predicting and preventing adverse events.
Objectives:
This study analyses the position of the HeartMate 3 left ventricular assist device on serial radiographs to assess positional change and possible correlation with adverse events.
Methods:
We retrospectively analysed 59 left ventricular assist device recipients who had serial chest radiographs at 1 month, 6 months and 12 months post-implantation between November 2014 and June 2018. We measured pump angle, pump-spine distance and pump-diaphragm depth and investigated their relationship to a composite outcome of heart failure readmission, low flow alarms, stroke or inflow/outflow occlusion requiring surgical repositioning through recurrent event survival modelling.
Results:
Between 1 and 6 months, the absolute pump-spine distance changed by 10.00 mm (P < 0.01) and the absolute pump-diaphragm depth changed by 18.80 mm (P < 0.01). These parameters did not change significantly between 6 and 12 months post-implantation. Pump angle did not change significantly over any period. Twenty-six patients experienced the composite outcome; in these patients, the median 1-month pump angle was 66.2° (interquartile range 54.5-78.0) as compared to 59.0° (interquartile range 47.0-65.0) in the 33 patients who did not have adverse events (P = 0.04). Pump depth and pump-spine distance at 1 month were not associated with the composite outcome. Change in pump depth between 1 and 6 months [hazard ratio (HR) 1.019; 95% confidence interval (CI) 1.000-1.039] and between 6 and 12 months (HR 1.020; 95% CI 1.000-1.040) were weakly associated with the composite outcome.
Conclusions:
Larger pump angles are associated with the composite outcome of position-related adverse events. Pump depth movement is weakly associated with the composite outcome.
