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HVAD Cannula Positioning is Associated with Higher GI Bleed Rates
Abstracts
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917 HVAD Cannula Positioning is Associated with Higher GI Bleed Rates T. Imamura, G. Kim, J. Raikhelkar, B. Smith, A. Nguyen, N. Narang, B. Chung, I. Ebong, L. Holzhauser, D. Nitta, T. Fujino, C. Juricek, P. Combs, T. Song, T. Ota, V. Jeevanandam, G. Sayer and N. Uriel. University of Chicago, Chicago, IL. Purpose: HVAD cannula positioning is associated with hemodynamics and heart failure readmissions. However, its impact on hemocompatibilityrelated adverse events (HRAEs) in general, and GI bleeding in particular, remains uncertain. This study assessed the impact of HVAD cannula positioning on HRAEs. Methods: HVAD patients were followed for one year following the index hospitalization discharge, when the cannula coronal angle was quantified from chest X-ray (Figure 1A). One-year freedom from any HRAEs and event rates of each HRAE were compared between those with and without cannula coronal angle >65 degrees. Results: Among 46 HVAD patients (median age 61 years, 76% male), 9 patients (20%) had cannula coronal angle >65 degrees. The rate of GI bleeding was significantly higher in the angle >65 group (1.03 vs. 0.19 events/year, p = 0.014). Rates of stroke and pump thrombosis were comparable irrespective of the cannula angle (p >0.05 for all; Figure 1B). One-year freedom from any HRAEs was numerically lower in the angle >65 group compared with the angle ≤65 group (22% vs. 63%, p = 0.062; Figure 1C). Conclusion: HVAD cannula coronal angle is associated with increased GI bleed. Prospective studies evaluating surgical techniques to ensure optimal device positioning and its effects on HRAEs are warranted.
Relationship between Inflow Malposition and Clinical Outcomes in HVAD Recipients E.N. Sorensen,1 E.D. Feller,1 D.J. Kaczorowski,1 L.M. Dees,1 V. Ton,1 R.J. Madathil,1 Z.N. Kon,2 and B.P. Griffith.1 1University of Maryland, Baltimore, MD; and the 2NYU Langone Medical Center, New York, NY. Purpose: We evaluated the effect of different inflow cannula malposition morphologies on readmission and selected complication rates in Heartware HVAD recipients. Methods: Inflow malposition was defined as the angular deviation from a line intersecting the apex and mitral orifice center in two CT imaging planes. Anterior plane deviation is toward the superior or inferior free wall. Lateral plane deviation is toward the septum or lateral wall. Total deviation is the sum of the two. Cutoffs for malposition were deviation ≥ 20 deg in any direction and total deviation ≥ 40 deg. Clinical outcomes were: 30-day and total cardiovascular-related readmissions (CVR; excludes bleeding, infections, noncardiac procedures, transplants); persistent VT/VF (pVT; ≥ 2 episodes); combined pump thrombosis (PT) or embolic stroke (PT-eCVA); and 90-day mortality. Results: 99 HVAD patients implanted since 2011 with postoperative CT scans were included. All were followed for complications. 87 were discharged and were assessed for CVR. Prevalence of each morphology of malposition is shown in Table. Deviation toward the inferior free wall occurred most frequently. Eighteen of 87 patients (21%) had 30-day CVR. Total deviation ≥ 40 deg was significantly associated with 30-day CVR (p=0.01). Median total CVR rate was 0.21/100 pt-days (IQR 0-0.68). Inferior wall deviation ≥ 20 deg was significantly associated with total CVR rate (p = 0.03). Eight of 99 patients (8.1%) had PT-eCVA (5 eCVA, 3 PT), 27% had pVT, and 90-day mortality occurred in 7%. No malposition measurement predicted any of these complications. Conclusion: PT-eCVA, pVT, and early mortality were not associated with malposition. However, worse overall malposition was associated with 30day CVR. Inferior wall malposition occurred in half of patients and was associated with overall CVR rate. Improved surgical planning techniques to mitigate malposition are warranted.
Prevalence of HVAD Malposition by Morphology Malposition morphology: All with CT (n = 99)
Discharged (n =87
Superior wall ≥ 20 deg Inferior wall ≥ 20 deg Septum ≥ 20 deg Lateral wall ≥ 20 deg Total deviation ≥ 40 deg
0 (0%) 43 (49%) 5 (6%) 11 (13%) 19 (22%)
0 (0%) 51 (52%) 7 (7%) 11 (11%) 23 (23%)
919 Patient-Tailored Silicone Plug for HeartMate 3TM Left Ventricular Assist Device Explantation C. Heim, N. Ebel, D.W. Schuberth, S. Werner, M. Kondruweit, R. Tandler and M. Weyand. University of Erlangen, Erlangen, Germany. Purpose: Cardiac recovery after mechanical circulatory support allows explantation of the left ventricular assist device (LVAD). So far, no FDA
S365
918
917 HVAD Cannula Positioning is Associated with Higher GI Bleed Rates T. Imamura, G. Kim, J. Raikhelkar, B. Smith, A. Nguyen, N. Narang, B. Chung, I. Ebong, L. Holzhauser, D. Nitta, T. Fujino, C. Juricek, P. Combs, T. Song, T. Ota, V. Jeevanandam, G. Sayer and N. Uriel. University of Chicago, Chicago, IL. Purpose: HVAD cannula positioning is associated with hemodynamics and heart failure readmissions. However, its impact on hemocompatibilityrelated adverse events (HRAEs) in general, and GI bleeding in particular, remains uncertain. This study assessed the impact of HVAD cannula positioning on HRAEs. Methods: HVAD patients were followed for one year following the index hospitalization discharge, when the cannula coronal angle was quantified from chest X-ray (Figure 1A). One-year freedom from any HRAEs and event rates of each HRAE were compared between those with and without cannula coronal angle >65 degrees. Results: Among 46 HVAD patients (median age 61 years, 76% male), 9 patients (20%) had cannula coronal angle >65 degrees. The rate of GI bleeding was significantly higher in the angle >65 group (1.03 vs. 0.19 events/year, p = 0.014). Rates of stroke and pump thrombosis were comparable irrespective of the cannula angle (p >0.05 for all; Figure 1B). One-year freedom from any HRAEs was numerically lower in the angle >65 group compared with the angle ≤65 group (22% vs. 63%, p = 0.062; Figure 1C). Conclusion: HVAD cannula coronal angle is associated with increased GI bleed. Prospective studies evaluating surgical techniques to ensure optimal device positioning and its effects on HRAEs are warranted.
Relationship between Inflow Malposition and Clinical Outcomes in HVAD Recipients E.N. Sorensen,1 E.D. Feller,1 D.J. Kaczorowski,1 L.M. Dees,1 V. Ton,1 R.J. Madathil,1 Z.N. Kon,2 and B.P. Griffith.1 1University of Maryland, Baltimore, MD; and the 2NYU Langone Medical Center, New York, NY. Purpose: We evaluated the effect of different inflow cannula malposition morphologies on readmission and selected complication rates in Heartware HVAD recipients. Methods: Inflow malposition was defined as the angular deviation from a line intersecting the apex and mitral orifice center in two CT imaging planes. Anterior plane deviation is toward the superior or inferior free wall. Lateral plane deviation is toward the septum or lateral wall. Total deviation is the sum of the two. Cutoffs for malposition were deviation ≥ 20 deg in any direction and total deviation ≥ 40 deg. Clinical outcomes were: 30-day and total cardiovascular-related readmissions (CVR; excludes bleeding, infections, noncardiac procedures, transplants); persistent VT/VF (pVT; ≥ 2 episodes); combined pump thrombosis (PT) or embolic stroke (PT-eCVA); and 90-day mortality. Results: 99 HVAD patients implanted since 2011 with postoperative CT scans were included. All were followed for complications. 87 were discharged and were assessed for CVR. Prevalence of each morphology of malposition is shown in Table. Deviation toward the inferior free wall occurred most frequently. Eighteen of 87 patients (21%) had 30-day CVR. Total deviation ≥ 40 deg was significantly associated with 30-day CVR (p=0.01). Median total CVR rate was 0.21/100 pt-days (IQR 0-0.68). Inferior wall deviation ≥ 20 deg was significantly associated with total CVR rate (p = 0.03). Eight of 99 patients (8.1%) had PT-eCVA (5 eCVA, 3 PT), 27% had pVT, and 90-day mortality occurred in 7%. No malposition measurement predicted any of these complications. Conclusion: PT-eCVA, pVT, and early mortality were not associated with malposition. However, worse overall malposition was associated with 30day CVR. Inferior wall malposition occurred in half of patients and was associated with overall CVR rate. Improved surgical planning techniques to mitigate malposition are warranted.
Prevalence of HVAD Malposition by Morphology Malposition morphology: All with CT (n = 99)
Discharged (n =87
Superior wall ≥ 20 deg Inferior wall ≥ 20 deg Septum ≥ 20 deg Lateral wall ≥ 20 deg Total deviation ≥ 40 deg
0 (0%) 43 (49%) 5 (6%) 11 (13%) 19 (22%)
0 (0%) 51 (52%) 7 (7%) 11 (11%) 23 (23%)
919 Patient-Tailored Silicone Plug for HeartMate 3TM Left Ventricular Assist Device Explantation C. Heim, N. Ebel, D.W. Schuberth, S. Werner, M. Kondruweit, R. Tandler and M. Weyand. University of Erlangen, Erlangen, Germany. Purpose: Cardiac recovery after mechanical circulatory support allows explantation of the left ventricular assist device (LVAD). So far, no FDA