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Published on: July 20, 2022
Left ventricular assist device and pump thrombosis: the importance of the inflow cannula position
Kirsten A Kortekaas1, Michiel A de Graaf2, Meindert Palmen3
1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. k.a.kortekaas@lumc.nl.
Insights
Left ventricular assist device (LVAD) implantation angle impacts pump thrombosis risk. A lateral inflow cannula angle significantly increases the likelihood of pump thrombosis, a serious LVAD complication.
Area of Science:
- Cardiology
- Medical Devices
- Biomedical Engineering
Background:
- Pump thrombosis is a severe complication following left ventricular assist device (LVAD) implantation.
- Understanding factors contributing to pump thrombosis is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the association between the implantation angle of the left ventricular assist device (LVAD) inflow cannula and the risk of pump thrombosis.
- To determine if specific LVAD implantation angles correlate with an increased incidence of pump thrombosis.
Main Methods:
- Retrospective analysis of 53 patients who underwent left ventricular assist device (LVAD) implantation between November 2010 and March 2020.
- Computed tomography scans were used to reconstruct the left ventricular axis and measure the inflow cannula implantation angle.
- Patients were analyzed for the occurrence of pump thrombosis during follow-up.
Main Results:
- A significant association was found between LVAD implantation angle and pump thrombosis (P=0.005).
- In 91% of patients with pump thrombosis, the inflow cannula was directed towards the lateral wall of the left ventricle.
- The mean angle towards the lateral wall was 10.1° in pump thrombosis patients versus 4.1° towards the septum in non-thrombosis patients.
Conclusions:
- The implantation angle of the left ventricular assist device (LVAD) inflow cannula is a significant factor associated with pump thrombosis.
- An LVAD implanted with the inflow cannula directed towards the lateral wall of the left ventricle demonstrates a higher risk of developing pump thrombosis.
Abstract:
Pump thrombosis is a devastating complication after left ventricular assist device implantation. This study aims to elucidate the relation between left ventricular assist device implantation angle and risk of pump thrombosis. Between November 2010 and March 2020, 53 left ventricular assist device-patients underwent a computed tomography scan. Using a 3-dimensional multiplanar reformation the left ventricular axis was reconstructed to measure the implantation angle of the inflow cannula. All patients were retrospectively analyzed for the occurrence of pump thrombosis. In 10 (91%) patients with a pump thrombosis, the implantation angle was towards the lateral wall of the left ventricle. In only 20 patients (49%) of the patients without a pump thrombosis the inflow cannula pointed towards the lateral wall of the left ventricle. The mean angle in patients with a pump thrombosis was 10.1 ± 11.9 degrees towards the lateral wall of the left ventricle compared to 4.1 ± 19.9 degrees towards the septum in non-pump thrombosis patients (P = 0.005). There was a trend towards a significant difference in time to first pump thrombosis between patients with a lateral or septal deviated left ventricular assist device (hazard ratio of 0.15, P = 0.07). This study demonstrates that left ventricular assist device implantation angle is associated with pump thrombosis. Almost all patients in whom a pump thrombosis occurred during follow-up had a left ventricular assist device implanted with the inflow-cannula pointing towards the lateral wall of the left ventricle.
