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Published on: July 20, 2022
Inflow cannula position as risk factor for stroke in patients with HeartMate 3 left ventricular assist devices
Thomas Schlöglhofer1,2,3, Philipp Aigner2,3, Marcel Migas3
1Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Insights
Inflow cannula malposition in HeartMate 3 (HM3) patients, identified via chest X-rays, is linked to neurological dysfunction and ischemic stroke. This malposition also predicts worse survival rates one year post-implantation.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Left ventricular assist device (LVAD) inflow cannula (IC) malposition has been associated with pump thrombus.
- The HeartMate 3 (HM3) device is a common LVAD, and its optimal positioning is crucial for patient outcomes.
Purpose of the Study:
- To determine if the position of the HeartMate 3 (HM3) LVAD inflow cannula (IC), assessed via chest X-rays, correlates with neurological dysfunction (ND), ischemic stroke (IS), hemorrhagic stroke (HS), and patient survival.
- To establish if standard chest X-rays can identify IC malposition as a risk factor for adverse events in HM3 recipients.
Main Methods:
- Retrospective analysis of chest X-rays from 42 HeartMate 3 (HM3) patients implanted between 2014 and 2017.
- Quantification of IC and pump position relative to anatomical landmarks (spine, diaphragm, horizontal line) in frontal and lateral X-rays.
- Primary endpoint: freedom from stroke and survival at one year, stratified by IC position.
Main Results:
- A significantly smaller IC angle was observed in HM3 patients with ND (0.1° ± 14.0°) compared to those without ND (12.9° ± 10.1°, p=0.005).
- HM3 patients who experienced IS had a significantly smaller IC angle in the frontal view (4.1° ± 20.9°) versus those without IS (13.8° ± 7.5°, p=0.004).
- An IC angle <10° predicted IS with 75% sensitivity and 100% specificity (C-statistic=0.85), correlating with lower freedom from IS (60% vs. 100%) and reduced one-year survival (71.8% vs. 100%).
Conclusions:
- Inflow cannula (IC) malposition, detectable on standard chest X-rays, is a significant risk factor for neurological dysfunction and ischemic stroke in HeartMate 3 (HM3) patients.
- IC malposition is associated with poorer one-year survival rates in HM3 recipients.
- Standard chest X-rays can effectively identify patients at higher risk for stroke and mortality following HM3 implantation.
Background:
A relation between the left ventricular assist device inflow cannula (IC) malposition and pump thrombus has been reported. This study aimed to investigate if the pump position, derived from chest X-rays in HeartMate 3 (HM3) patients, correlates with neurological dysfunction (ND), ischemic stroke (IS), hemorrhagic stroke (HS) and survival.
Methods:
This analysis was performed on routinely acquired X-rays of 42 patients implanted with a HM3 between 2014 and 2017. Device position was quantified in patients with and without ND from frontal and lateral X-rays characterizing the IC and pump in relation to spine, diaphragm or horizontal line. The primary end-point was freedom from stroke and survival one-year after HM3 implantation stratified by pump position.
Results:
The analysis of X-rays, 33.5 (41.0) days postoperative, revealed a significant smaller IC angle of HM3 patients with ND versus no ND (0.1° ± 14.0° vs. 12.9° ± 10.1°, p = 0.005). Additionally, the IC angle in the frontal view, IS: 4.1 (20.9)° versus no IS: 13.8 (7.5)°, p = 0.004 was significantly smaller for HM3 patients with IS. Using receiver operating characteristics derived cut-off, IC angle <10° provided 75% sensitivity and 100% specificity (C-statistic = 0.85) for predicting IS. Stratified by IC angle, freedom from IS at 12 months was 100% (>10°) and 60% (<10°) respectively (p = 0.002). No significant differences were found in any end-point between patients with and without HS. One-year survival was significantly higher in patients with IC angle >10° versus <10° (100% vs. 71.8%, p = 0.012).
Conclusions:
IC malposition derived from standard chest X-rays serves as a risk factor for ND, IS and worse survival in HM3 patients.
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