scholarly journals P819 Outflow graft twist occlusion in the heartmate 3 left ventricular assist system in 7 cases: analysis of potential mechanisms using computed tomography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
N Solowjowa ◽  
D Zimpfer ◽  
M Mueller ◽  
H Krastev ◽  
V Falk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Left Ventricular ◽  
Specific Pattern ◽  
Implantation Technique ◽  
Ventricular Assist ◽  
Inflow Cannula ◽  
Valve Opening ◽  
Outflow Channel ◽  
Outflow Graft

Abstract Background Twist of the outflow graft (OG) of the HeartMate 3 left ventricular (LV) assist device (HM3) with subsequent occlusion is a rare, but life-threatening complication. Purpose We evaluated if potential implantation technique dependent mechanisms of OG twist can be predicted by multislice computed tomography (MSCT). Methods We retrospectively analyzed clinical, echocardiographic and MSCT data of 7 patients with angiographically proven and surgically corrected OG twist and of 11 consecutive patients without any type of pump obstruction. MSCT parameters were: position of inflow cannula related to anatomical LV apex (1), angulation of axis of inflow cannula related to LV axis (2), orientation of outflow channel of the pump housing related to LV axis (3), OG course (4). Echocardiographic parameters were LV end-diastolic diameter (LVEDD) and aortic valve opening. Results Mean time from implantation to twist was 563 ± 161 days. Preoperative LVEDD (64.6 ± 9.8 mm vs. 67.4 ± 10.2 mm, p = 0.563) was similar. LVEDD reduction after implantation (20% vs. 28%) and prevalence of aortic valve opening was higher in the twist group (71% vs. 45%). The MSCT measurements showed a high degree of heterogeneity in both groups: (1) differed from superior to infero-lateral; (2) varied from cranial to caudal, lateral and medial; (3) varied from antero-septal to inferior. (4) showed an incidence of non-obstructive kinking of 29% and 36%, respectively. Conclusion Marked heterogeneity of the measured MSCT parameters was observed in both groups. No specific pattern or geometric relation could be attributed to the OG twist phenomenon.

Pulse assessment is important with blood pressure measurement in individuals with continuous flow left ventricular assist devices

2020 ◽  
pp. 039139882092702
Author(s):  
Hernan G Marcos-Abdala ◽  
Ana S Cruz-Solbes ◽  
Imad Hussain ◽  
Barry Trachtenberg ◽  
Guha Ashrith ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Valve ◽  
Continuous Flow ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist ◽  
Valve Opening

While Doppler and cuff blood pressure techniques are prevalent methods of assessing blood pressure in patients with continuous flow left ventricular assist devices, the impact of pulsatility on measurement is not well established. Retrospective chart analysis of clinical variables including pulse perception, blood pressure (Doppler and standard cuff), and aortic valve opening on echo at clinic visit were abstracted. Stable outpatients on continuous flow left ventricular assist devices support with concomitant portable echo assessment were included. Mean average difference was calculated and Pearson’s correlation performed for all those patients who had both Doppler and cuff pressure obtained. In all, 74 Heartmate-II patients with a median time from implant of 380 days were analyzed. A pulse was perceived in 82% of patients with persistent aortic valve opening on portable echo and also in 30% of those who had a persistently closed aortic valve. The mean average difference between the Doppler and systolic cuff pressure was ~13 mmHg ( r = 0.5, p = 0.004) when a pulse was present and ~11 mmHg when aortic valve was open ( r = 0.68, p < 0.0001). Pulse presence seems to reflect aortic valve opening a majority of the time but not always. In the presence of a prominent pulse or persistent aortic valve opening, the Doppler pressure seems to be more reflective of a systolic pressure than mean perfusion pressure. Hence, assessment of pulsatility needs to be incorporated into blood pressure measurement methods for patients with continuous flow left ventricular assist devices.

scholarly journals Computed Tomography and Fluoroscopic Angiography in Management of Left Ventricular Assist Device Outflow Graft Obstruction

2020 ◽  
Vol 13 (9) ◽  
pp. 2036-2042 ◽  
Author(s):  
Isaac Wamala ◽  
Simon Kneissler ◽  
Friedrich Kaufmann ◽  
Jaime-Jürgen Eulert-Grehn ◽  
Evgenij Potapov ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Outflow Graft

scholarly journals Hemodynamic Effects of Concentric and Eccentric Outflow Graft of LVADs on the Aortic Valve

2020 ◽  
Author(s):  
Zhiming Song ◽  
Lufeng Zhang ◽  
Yagang Ding ◽  
Qing Wan ◽  
Yunzhen Feng ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Coupled Model ◽  
Left Ventricular ◽  
Closing Time ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Particle Hydrodynamics ◽  
Smoothed Particle ◽  
Hemodynamic Force ◽  
Outflow Graft

Abstract Background: Aortic valve disease is a common complication of left ventricular assist device (LVAD) support. Optimizing the outflow graft anastomotic type of LVADs might be an alternative that can reduce this complication. However, the effect of this type of LVAD on the biomechanical states of the aortic valve remains unclear.Methods: In this study, a finite element-smoothed particle hydrodynamics-coupled model was established. Two kinds of anastomotic types (concentric and eccentric graft cases) were designed.Results: The anastomotic type could significantly affect the biomechanical states of the aortic valve. During the opening phase, the motion, deformation, and biomechanical states of the leaflet in both cases were similar to each other. The axial hemodynamic force (AHF) imposed on the leaflet in the eccentric graft case (0.9 N) was slightly larger than that in the concentric graft case (0.3 N). During the closing phase, the rapid closing time of the leaflet in the eccentric graft case (40 ms) was longer than that in the concentric graft case (15 ms). In addition, the peak value of the AHF in the concentric graft case was much larger (13 N) than that in the eccentric graft case (4.5 N). The oscillation of the AHF was observed only in the concentric graft case.Conclusions: The eccentric graft could lead to better biomechanical and hemodynamic states of the aortic valve than the concentric graft.

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