Division of Cardiology, University of Chicago Medical Center, Chicago, IL, USA.
Second Department of Internal Medicine, University of Toyama, Toyama, Toyama, Japan.
Artif Organs. 2020 Dec;44(12):e509-e519. doi: 10.1111/aor.13755. Epub 2020 Jul 20.
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.
心泰能 II 型和 HeartWare 左心室辅助装置（LVAD）的套管位置与临床结果相关。本研究旨在探讨心泰能 3 型 LVAD 队列中装置定位的临床意义。连续接受心泰能 3 型 LVAD 植入的患者从索引出院开始随访一年。在索引出院时，测量胸部 X 线参数：（a）套管冠状角，（b）泵底高度，（c）套管矢状角和（d）套管管腔面积。研究了套管位置的每个测量值与一年临床结果的关联。共纳入 64 例心泰能 3 型 LVAD 患者（58 岁，64%为男性）。在多变量 Cox 回归模型中，套管冠状角是死亡或心力衰竭再入院的显著预测因素（危险比 1.27[1.01-1.60]，P =.045）。套管冠状角≤28°的患者中心静脉压较低（P =.030），肺毛细血管楔压较低（P =.027），左心室较小（P =.019）与角度>28°的患者相比。狭窄角组的右心室大小和右心室功能参数也更好，一年累积死亡或心力衰竭再入院的发生率也较低（10%对 50%，P =.008）。心泰能 3 型 LVAD 患者套管冠状角狭窄与心脏卸载改善和死亡或心力衰竭再入院发生率降低相关。需要更大的研究来证实最佳设备定位的意义。
