Optimal cannula positioning of HeartMate 3 left ventricular assist device

Abstract

The Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 (MOMENTUM 3) and HeartMate 3 CE Mark studies recently demonstrated that HeartMate 3, a fully magnetically levitated centrifugal-flow left ventricular assist device (LVAD) (Abbott, Abbott Park, IL), 1 has a higher survival rate and a lower rate of hemocompatibility-related adverse events (HRAEs) compared to HeartMate II LVAD (Abbott, Abbott Park, IL). 2-7 Despite extremely low rates of pump thrombosis and stroke, readmissions due to decompensated heart failure (HF) and gastrointestinal bleeding remain still common. 2

Inflow cannula position as risk factor for stroke in patients with HeartMate 3 left ventricular assist devices

“…The potential clinical impact of IC angle determined by X‐rays, has been suspected by Imamura et al 19 who reported—on the other end—that larger coronal angles (CCA >28°) as a significant predictor of death or heart failure readmission. A well‐positioned pump is expected to result in improved hemodynamics with better unloading and reduced right ventricular function.…”

“…The first standing X‐ray was used for analysis, and X‐rays were checked for postural inconsistencies by verifying for alignment of the spine with the vertical axis, symmetric position of the clavicular heads and symmetric arm posture. Pump depth (distance between the dome of the right hemi diaphragm and the bottom of the pump body), projected IC length and IC angle (angle of the IC against a horizontal reference line) were analyzed similarly to previously reported data 8,19 . Additionally, elliptical approximations of the IC tip and the area of the projected pump body including the short and long elliptical axis, 17 were evaluated in both projections.…”

“…Pump depth (distance between the dome of the right hemi diaphragm and the bottom of the pump body), projected IC length and IC angle (angle of the IC against a horizontal reference line) were analyzed similarly to previously reported data. 8 , 19 Additionally, elliptical approximations of the IC tip and the area of the projected pump body including the short and long elliptical axis, 17 were evaluated in both projections. In the PA X‐rays, the horizontal line was checked for possible rotation of the patient and corrected if necessary (>1° rotation) by defining it perpendicular to the spline.…”

“…Recently, it has been shown that correlations exist between computer tomography (CT) angles and radiographs 17 ; therefore, assessment and identification of pump position related risk factors can be easily accomplished by routine chest radiographs. 18 Even though, only two reports among HM3 patients linked death and heart failure readmission 19 or composite adverse events 20 to pump position.…”

The Impact of Intrapericardial versus Intrapleural HeartMate 3 Pump Placement on Clinical Outcomes

“…The incidence of late inflow or outflow obstruction in these HM3 patients was 3%, with two-thirds requiring surgical intervention. The prior literature has demonstrated the deleterious effects of pump mobility and the inflow cannula angle, though much of the data involve the HM2 and therefore are unable to provide insights on location as a predictive variable [ 6 , 11 - 13 ]. We previously published our experience with 59 HM3 patients, demonstrating no difference in the rates of VAD malposition and misalignment regardless of pericardial or thoracic placement [ 14 ].…”