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Optimal cannula positioning of HeartMate 3 left ventricular assist device
Author(s) -
Imamura Teruhiko,
Narang Nikhil,
Nitta Daisuke,
Fujino Takeo,
Nguyen Ann,
Kim Gene,
Raikhelkar Jayant,
Rodgers Daniel,
Ota Takeyoshi,
Jeevanandam Valluvan,
Sayer Gabriel,
Uriel Nir
Publication year - 2020
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.13755
Subject(s) - cannula , medicine , ventricular assist device , pulmonary wedge pressure , coronal plane , cardiology , heart failure , hazard ratio , surgery , radiology , confidence interval
Cannula position in HeartMate II and HeartWare left ventricular assist devices (LVADs) is associated with clinical outcome. This study aimed to investigate the clinical implication of the device positioning in HeartMate 3 LVAD cohort. Consecutive patients who underwent HeartMate 3 LVAD implantation were followed for one year from index discharge. At index discharge, chest X‐ray parameters were measured: (a) cannula coronal angle, (b) height of pump bottom, (c) cannula sagittal angle, and (d) cannula lumen area. The association of each measurement of cannula position with one‐year clinical outcomes was investigated. Sixty‐four HeartMate 3 LVAD patients (58 years old, 64% male) were enrolled. In the multivariable Cox regression model, the cannula coronal angle was a significant predictor of death or heart failure readmission (hazard ratio 1.27 [1.01‐1.60], P = .045). Patients with a cannula coronal angle ≤28° had lower central venous pressure ( P = .030), lower pulmonary capillary wedge pressure ( P = .027), and smaller left ventricular size ( P = .019) compared to those with the angle >28°. Right ventricular size and parameters of right ventricular function were also better in the narrow angle group, as was one‐year cumulative incidence of death or heart failure readmission (10% vs. 50%, P = .008). Narrow cannula coronal angle in patients with HeartMate 3 LVADs was associated with improved cardiac unloading and lower incidence of death or heart failure readmission. Larger studies to confirm the implication of optimal device positioning are warranted.