title: Postimplant left ventricular assist device fit analysis using three-dimensional reconstruction.
abstract: Left ventricular assist devices (LVADs) are blood pumps that augment the function of the failing heart to improve perfusion, resulting in improved survival. For LVADs to effectively unload the left ventricle, the inflow cannula (IC) should be unobstructed and ideally aligned with the heart's mitral valve (MV). We examined IC orientation deviation from a hypothesized conventional angle (45° right-posterior) and the approximate angle for direct IC-MV alignment in many patients. Three-dimensional anatomic models were created from computed tomography scans for 24 LVAD-implanted patients, and angles were measured between the IC and the apical z-axis in both the coronal and the sagittal planes. Common surgical IC angulation was found to be 22 ± 15° rightward and 21 ± 12° posterior from the apical z-axis; 38% (n = 9) of patients fell in this range. Direct IC-MV angulation was found to be 34 ± 8° rightward and 15 ± 7° posterior; only 8% (n = 2) of patients fell in this range. Rightward deviation toward ventricular septal wall and anterior deviation toward LV anterior freewall are associated with mortalities more so than leftward and posterior deviation. In conclusion, anatomic reconstruction may be a useful preoperative tool to obtain general population and patient-specific alignment for optimal LVAD implantation.
authors.affiliation: From the *Nazhi Zudhi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma; †Department of Cardiothoracic Surgery, College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma; and ‡Department of Mechanical Engineering, University of Utah, Salt Lake City, Utah.
authors.forename: Thang V
authors.initials: TV
authors.lastname: Truong
authors.forename: J Ryan
authors.initials: JR
authors.lastname: Stanfield
authors.forename: John S
authors.initials: JS
authors.lastname: Chaffin
authors.forename: C Craig
authors.initials: CC
authors.lastname: Elkins
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Kanaly
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Horstmanshof
authors.forename: James W
authors.initials: JW
authors.lastname: Long
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Snyder
mesh_terms: D000328:Adult; D000368:Aged; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D014057:Tomography, X-Ray Computed