CT-based cannula position predicts neurological risk in patients with HeartMate 3 LVAD

Area of Science:

• Cardiology
• Biomedical Engineering
• Neurosurgery

Background:

• Adverse neurological events (ANE) remain a significant concern in HeartMate 3 (HM3) left ventricular assist device (LVAD) recipients, despite improved hemocompatibility.
• Limited data exists on the impact of combined inflow and outflow cannula positioning on ANE risk.

Purpose of the Study:

• To investigate the association between inflow and outflow cannula positioning and the incidence of ANE in HM3 LVAD recipients.
• To identify optimal cannula orientation parameters to potentially mitigate stroke risk.

Main Methods:

• Single-center retrospective study of 103 HM3 recipients (2016-2024) using contrast-enhanced cardiac CT.
• Quantification of inflow angle, inflow depth, distance to anterior wall, and outflow angle.
• Analysis of ANE association using Kaplan-Meier and multivariable Cox regression, with optimal cutoffs determined by ROC analysis.

Main Results:

• 24% of patients experienced ANE over a median follow-up of 3.1 years.
• Shallower inflow depth (≤ 14.5 mm) and inflow angles closer to the inferior wall (≤ -4.1°) were independently associated with increased ANE risk.
• Larger outflow angles (> 42.7°) were also independently associated with ANE.
• A higher number of cannula-related anatomical risk factors correlated with worse 5-year ANE-free survival.

Conclusions:

• Shallower inflow depth, inferiorly directed inflow angle, and larger outflow angle are significantly associated with ANE in HM3 patients.
• Optimizing cannula orientation during implantation is crucial for potentially reducing stroke risk in this patient population.