title: Utility of cardiac computed tomography for inflow cannula patency assessment and prediction of clinical outcome in patients with the HeartMate II left ventricular assist device.
abstract: OBJECTIVE
  Proper inflow cannula orientation during implantation of the HeartMate II (HMII) left ventricular assist device (LVAD) is important for optimal pump function. This article describes our experience with cardiac computed tomography (CCT) to evaluate inflow cannula patency and predict future adverse outcomes (AE) after HMII LVAD implantation.
  
  
  METHODS
  Ninety-three patients underwent HMII LVAD implantation for end-stage cardiomyopathy from January 2010 until March 2014. A total of 25 consecutive patients had CCT after the implantation; 3 patients were excluded from the analysis due to associated abnormality of the outflow graft. The 22 patients with CCT after HMII LVAD were censored for adverse events related to LVAD malfunction after HMII LVAD implantation. The maximum percentage of inflow cannula obstruction on CCT was recorded. We analysed the predictive value of CCT in addition to other clinical and diagnostic variables for future AEs.
  
  
  RESULTS
  Seven of the 22 patients (32%) experienced AEs after HMII LVAD implantation. The degree of inflow cannula obstruction was higher in the group of patients who experienced an AE (70 vs 14%; P < 0.001). Inflow cannula obstruction >30% showed excellent correlation with AE longitudinally based on receiver operating curve (0.829). The group with AEs more frequently experienced CHF symptoms (P = 0.054).
  
  
  CONCLUSIONS
  Inflow cannula obstruction >30% on CCT predicts future adverse events in patients with HMII LVAD; the need for surgical intervention in terms of LVAD exchange or urgent listing for heart transplantation should be considered in good surgical risk patients. Cardiac computed tomography should be considered routinely postoperatively in patients with HMII LVAD.
authors.affiliation: Department of Radiology, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Sacks
authors.affiliation: Department of Heart Transplantation and Mechanical Circulatory Support, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Gonzalo V
authors.initials: GV
authors.lastname: Gonzalez-Stawinski
authors.affiliation: Department of Heart Transplantation and Mechanical Circulatory Support, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Shelley
authors.initials: S
authors.lastname: Hall
authors.affiliation: Department of Heart Transplantation and Mechanical Circulatory Support, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Lima
authors.affiliation: Department of Heart Transplantation and Mechanical Circulatory Support, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: MacHannaford
authors.affiliation: Department of Radiology, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: William
authors.initials: W
authors.lastname: Dockery
authors.affiliation: Department of Radiology, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Marco
authors.initials: M
authors.lastname: Cura
authors.affiliation: Department of Heart Transplantation and Mechanical Circulatory Support, Baylor University Medical Center, Dallas, TX, USA National and Kapodistrian University of Athens, Athens, Greece themistokles.chamogeorgakis@baylorhealth.edu.
authors.forename: Themistokles
authors.initials: T
authors.lastname: Chamogeorgakis
mesh_terms: D000072601:Cannula; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D006353:Heart-Assist Devices; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: HeartMateII; Inflow cannula; Left ventricular assist device; Obstruction