Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria.
Artif Organs. 2022 Jun;46(6):1149-1157. doi: 10.1111/aor.14165. Epub 2022 Jan 9.
A relation between the left ventricular assist device inflow cannula (IC) malposition and pump thrombus has been reported. This study aimed to investigate if the pump position, derived from chest X-rays in HeartMate 3 (HM3) patients, correlates with neurological dysfunction (ND), ischemic stroke (IS), hemorrhagic stroke (HS) and survival.
This analysis was performed on routinely acquired X-rays of 42 patients implanted with a HM3 between 2014 and 2017. Device position was quantified in patients with and without ND from frontal and lateral X-rays characterizing the IC and pump in relation to spine, diaphragm or horizontal line. The primary end-point was freedom from stroke and survival one-year after HM3 implantation stratified by pump position.
The analysis of X-rays, 33.5 (41.0) days postoperative, revealed a significant smaller IC angle of HM3 patients with ND versus no ND (0.1° ± 14.0° vs. 12.9° ± 10.1°, p = 0.005). Additionally, the IC angle in the frontal view, IS: 4.1 (20.9)° versus no IS: 13.8 (7.5)°, p = 0.004 was significantly smaller for HM3 patients with IS. Using receiver operating characteristics derived cut-off, IC angle <10° provided 75% sensitivity and 100% specificity (C-statistic = 0.85) for predicting IS. Stratified by IC angle, freedom from IS at 12 months was 100% (>10°) and 60% (<10°) respectively (p = 0.002). No significant differences were found in any end-point between patients with and without HS. One-year survival was significantly higher in patients with IC angle >10° versus <10° (100% vs. 71.8%, p = 0.012).
IC malposition derived from standard chest X-rays serves as a risk factor for ND, IS and worse survival in HM3 patients.
左心室辅助装置（LVAD）流入管（IC）位置不当与泵血栓之间存在相关性。本研究旨在探讨 HeartMate 3（HM3）患者的泵位置与神经功能障碍（ND）、缺血性卒中（IS）、出血性卒中（HS）和生存率之间的关系。
对 2014 年至 2017 年间植入 HM3 的 42 例患者的常规胸部 X 射线进行了分析。从正面和侧面 X 射线对有和无 ND 的患者的设备位置进行定量分析，以描述 IC 和泵与脊柱、膈肌或水平线的关系。主要终点是根据 HM3 植入后泵位置分层的卒中无复发和 1 年生存率。
术后 33.5（41.0）天的 X 射线分析显示，ND 患者的 HM3 IC 角度明显小于无 ND 患者（0.1°±14.0° vs. 12.9°±10.1°，p=0.005）。此外，HM3 患者 IS 的 IC 角度在正面视图中更小（IS：4.1（20.9）° vs. 无 IS：13.8（7.5）°，p=0.004）。使用接收者操作特征曲线（ROC）得出的截断值，IC 角度<10°对预测 IS 的灵敏度为 75%，特异性为 100%（C 统计量=0.85）。按 IC 角度分层，12 个月时无 IS 的发生率为 100%（>10°）和 60%（<10°）（p=0.002）。在有和无 HS 的患者之间，任何终点均无显著差异。IC 角度>10°的患者 1 年生存率明显高于<10°的患者（100% vs. 71.8%，p=0.012）。
标准胸部 X 射线显示的 IC 错位是 HM3 患者 ND、IS 和生存率降低的危险因素。
