Pump position and thrombosis in ventricular assist devices: Correlation of radiographs and CT data

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Left ventricular assist devices (LVADs) are crucial for heart failure management.
• LVAD malpositioning is a known risk factor for pump thrombosis.
• Identifying LVAD malposition from clinical imaging is challenging.

Purpose of the Study:

• To identify imaging parameters from routine X-rays and CT scans that correlate with pump thrombosis in LVAD patients.
• To determine if radiographs can reliably detect malpositioned LVADs and predict thrombosis risk.

Main Methods:

• Retrospective analysis of imaging data (X-ray, CT) from 115 LVAD patients (HeartmateII and HVAD).
• Comparison of imaging parameters between patients with pump thrombosis (PT) and a matched control group (NT).
• Analysis of inflow cannula angles (α and β) in CT scans and correlation with radiographic findings.

Main Results:

• In HVAD patients, specific radiographic measurements (pump body area, minor axis) and inflow cannula visibility predicted pump thrombosis.
• CT analysis revealed significant differences in inflow cannula angle α between PT and NT groups in HVAD patients.
• Routine radiographs demonstrated a correlation with CT angles, indicating their utility in identifying malpositioned LVADs.
• No specific radiographic parameters were associated with pump thrombosis in HeartmateII patients.

Conclusions:

• Routine radiographs can effectively identify malpositioned LVADs, particularly the HVAD.
• Posterior rotation of the HVAD inflow cannula, detectable on radiographs, is associated with an increased risk of pump thrombosis.
• Ensuring proper inflow cannula alignment is critical for preventing LVAD pump thrombosis.