Relapsing low-flow alarms due to suboptimal alignment of the left ventricular assist device inflow cannula

• Published in: European journal of cardio-thoracic surgery 2022-09, Vol.62 (4)
• Main Authors: Zijderhand, Casper F, Knol, Wiebe G, Budde, Ricardo P J, van der Heiden, Cornelis W, Veen, Kevin M, Sjatskig, Jelena, Manintveld, Olivier C, Constantinescu, Alina A, Birim, Ozcan, Bekkers, Jos A, Bogers, Ad J J C, Caliskan, Kadir
• Format: Article
• Language: English
• Subjects: Cannula; Female; Heart Failure - surgery; Heart Ventricles; Heart-Assist Devices; Humans; Male; Middle Aged; Quality of Life; Retrospective Studies; Tomography, X-Ray Computed
• ISSN: 1873-734X; 1873-734X
• DOI: 10.1093/ejcts/ezac415

This retrospective study investigated the correlation between the angular position of the left ventricular assist device (LVAD) inflow cannula and relapsing low-flow alarms. Medical charts were reviewed of all patients with HeartMate 3 LVAD support for relapsing low-flow alarms. A standardized protocol was created to measure the angular position with a contrast-enhanced computed tomography scan. Statistics were done using a gamma frailty model with a constant rate function. For this analysis, 48 LVAD-supported patients were included. The majority of the patients were male (79%) with a median age of 57 years and a median follow-up of 30 months (interquartile range: 19-41). Low-flow alarm(s) were experienced in 30 (63%) patients. Angulation towards the septal-lateral plane showed a significant increase in low-flow alarms over time with a constant rate function of 0.031 increase in low-flow alarms per month of follow-up per increasing degree of angulation (P = 0.048). When dividing this group using an optimal cut-off point, a significant increase in low-flow alarms was observed when the septal-lateral angulation was 28° or more (P = 0.001). Anterior-posterior and maximal inflow cannula angulation did not show a significant difference. This study showed an increasing number of low-flow alarms when the degrees of LVAD inflow cannula expand towards the septal-lateral plane. This emphasizes the importance of the LVAD inflow cannula angular position to prevent relapsing low-flow alarms with the risk of diminished quality of life and morbidity.