scholarly journals Understanding the influence of left ventricular assist device inflow cannula alignment and the risk of intraventricular thrombosis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Michael Neidlin ◽  
Sam Liao ◽  
Zhiyong Li ◽  
Benjamin Simpson ◽  
David M. Kaye ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Patient Specific ◽  
Free Wall ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Inflow Cannula ◽  
The Ideal

Abstract Background Adverse neurological events associated with left ventricular assist devices (LVADs) have been suspected to be related to thrombosis. This study aimed to understand the risks of thrombosis with variations in the implanted device orientation. A severely dilated pulsatile patient-specific left ventricle, modelled with computational fluid dynamics, was utilised to identify the risk of thrombosis for five cannulation angles. With respect to the inflow cannula axis directed towards the mitral valve, the other angles were 25° and 20° towards the septum and 20° and 30° towards the free wall. Results Inflow cannula angulation towards the free wall resulted in longer blood residence time within the ventricle, slower ventricular washout and reduced pulsatility indices along the septal wall. Based on the model, the ideal inflow cannula alignment to reduce the risk of thrombosis was angulation towards the mitral valve and up to parallel to the septum, avoiding the premature clearance of incoming blood. Conclusions This study indicates the potential effects of inflow cannulation angles and may guide optimised implantation configurations; however, the ideal approach will be influenced by other patient factors and is suspected to change over the course of support.

scholarly journals Left Ventricular Assist Device Implantation via Bi-Thoracotomy Technique: A Single-Center Perspective

2021 ◽  
Author(s):  
Elizabeth Stoeckl ◽  
Jason Smith ◽  
Ravi Dhingra ◽  
Amy Fiedler
Keyword(s):  
Heart Function ◽  
Length Of Hospital Stay ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Right Heart Function ◽  
Device Implantation ◽  
Left Ventricular Assist ◽  
Inflow Cannula

Background: Left ventricular assist devices (LVAD) are standardly implanted via full sternotomy. Non-sternotomy approaches are gaining popularity, but potential benefits of this approach have not been well-studied. We hypothesized that LVAD implantation by bi-thoracotomy (BT) would demonstrate smaller and more consistent inflow cannula angles leading to improved postoperative outcomes compared to sternotomy. Methods: Charts of patients who underwent LVAD implantation between June 2018 and June 2020 at a single academic institution were retrospectively reviewed. Patient demographics, surgical approach (sternotomy vs. BT), laboratory values, and postoperative course were compared. The inflow cannula angle was measured on the first chest radiograph available postoperatively. Results: Of 40 patients studied, BT approach was used in 17 (42.5%). Mean inflow cannula angles were smaller in BT patients (23.0 vs. 37.1 degrees, p=0.018) and had a smaller standard deviation (13.8 vs. 20.3). Excluding patients who went on to receive heart transplant or died in the same hospitalization, there was no difference in median length of hospital stay after surgery (16.0 vs. 17.5 days, p=0.768). However, BT patients required fewer days of postoperative inotrope support (4.0 vs. 7.0 days, p=0.012). Conclusions: Our data suggest inflow cannula angles are smaller and more consistent with the BT approach, which leads to shorter duration of postoperative inotropic support. This finding may suggest improved right heart function following LVAD implant via BT approach. Further study is warranted to determine additional benefits of the BT approach.

scholarly journals Innovative Modeling Techniques and 3D Printing in Patients with Left Ventricular Assist Devices: A Bridge from Bench to Clinical Practice

2019 ◽  
Vol 8 (5) ◽  
pp. 635
Author(s):  
Rishi Thaker ◽  
Raquel Araujo-Gutierrez ◽  
Hernan G. Marcos-Abdala ◽  
Tanushree Agrawal ◽  
Nadia Fida ◽  
...  
Keyword(s):  
3D Printing ◽  
Left Ventricular ◽  
Flow Dynamics ◽  
Ventricular Assist Devices ◽  
Patient Specific ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist ◽  
Modeling Techniques

Left ventricular assist devices (LVAD) cause altered flow dynamics that may result in complications such as stroke, pump thrombosis, bleeding, or aortic regurgitation. Understanding altered flow dynamics is important in order to develop more efficient and durable pump configurations. In patients with LVAD, hemodynamic assessment is limited to imaging techniques such as echocardiography which precludes detailed assessment of fluid dynamics. In this review article, we present some innovative modeling techniques that are often used in device development or for research purposes, but have not been utilized clinically. Computational fluid dynamic (CFD) modeling is based on computer simulations and particle image velocimetry (PIV) employs ex vivo models that helps study fluid characteristics such as pressure, shear stress, and velocity. Both techniques may help elaborate our understanding of complications that occur with LVAD and could be potentially used in the future to troubleshoot LVAD-related alarms. These techniques coupled with 3D printing may also allow for patient-specific device implants, lowering the risk of complications increasing device durability.

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