Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
Artif Organs. 2024 Dec;48(12):1502-1512. doi: 10.1111/aor.14837. Epub 2024 Aug 6.
Left ventricular assist device (LVAD) malposition has been linked to hemocompatibility-related adverse events (HRAEs). This study aimed to identify preoperative anatomical landmarks and postoperative pump position, associated with HRAEs during LVAD support.
Pre- and postoperative chest X-ray measures (≤14 days pre-implantation, first postoperative standing, 6, 12, 18, and 24 months post-implantation) were analyzed for their association with HRAEs over 24 months in 33 HeartMate 3 (HM3) patients (15.2% female, age 66 (9.5) years).
HM3 patients with any HRAE showed significantly lower preoperative distances between left ventricle and thoracic outline (dLVT) (25.3 ± 10.2 mm vs. 40.3 ± 15.5 mm, p = 0.004). A ROC-derived cutoff dLVT ≤ 29.2 mm provided 85.7% sensitivity and 72.2% specificity predicting any HRAE during HM3 support (76.2% (>29.2 mm) vs. 16.7% (≤29.2 mm) freedom from HRAE, p < 0.001) and significant differences in cardiothoracic ratio (0.58 ± 0.04 vs. 0.62 ± 0.04, p = 0.045). Postoperative X-rays indicated lower pump depths in patients with ischemic strokes (9.1 ± 16.2 mm vs. 38.0 ± 18.5 mm, p = 0.007), reduced freedom from any neurological event (pump depth ≤ 28.7 mm: 45.5% vs. 94.1%, p = 0.004), and a significant correlation between pump depth and inflow cannula angle (r = 0.66, p < 0.001). Longitudinal changes were observed in heart-pump width (F(4,60) = 5.61, p < 0.001).
Preoperative X-ray markers are associated with postoperative HRAE occurrence. Applying this knowledge in clinical practice may enhance risk stratification, guide therapy optimization, and improve HM3 recipient management.
左心室辅助装置（LVAD）位置不当与血液相容性相关的不良事件（HRAEs）有关。本研究旨在确定术前解剖学标志和术后泵位置与 LVAD 支持期间 HRAEs 的关系。
对 33 例 HeartMate 3（HM3）患者（15.2%为女性，年龄 66[9.5]岁）的术前和术后胸部 X 射线测量值（植入前≤14 天、术后首次站立、植入后 6、12、18 和 24 个月）进行分析，以确定 24 个月内 HRAEs 的相关性。
任何 HRAE 的 HM3 患者术前左心室与胸壁轮廓之间的距离（dLVT）明显降低（25.3±10.2mm 与 40.3±15.5mm，p=0.004）。ROC 衍生的 dLVT≤29.2mm 切点提供了 85.7%的敏感性和 72.2%的特异性，预测 HM3 支持期间任何 HRAE（76.2%（>29.2mm）与 16.7%（≤29.2mm）HRAE 无事件自由，p<0.001）和心胸比（0.58±0.04 与 0.62±0.04，p=0.045）显著差异。术后 X 射线显示，缺血性中风患者的泵深度较低（9.1±16.2mm 与 38.0±18.5mm，p=0.007），任何神经事件无事件自由率降低（泵深度≤28.7mm：45.5%与 94.1%，p=0.004），并且泵深度与流入管角度之间存在显著相关性（r=0.66，p<0.001）。心泵宽度观察到纵向变化（F（4，60）=5.61，p<0.001）。
术前 X 射线标志物与术后 HRAE 的发生有关。在临床实践中应用这一知识可以增强风险分层，指导治疗优化，并改善 HM3 受者的管理。
