Extracorporeal driveline vibrations to detect left ventricular assist device thrombosis - A porcine model study.

Autor: Lilja D; The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: didlil@ous-hf.no., Schalit I; The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway., Espinoza A; The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway., Hoel TN; Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway., Larsen G; The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway., Pettersen FJ; Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway., Halvorsen PS; The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Jazyk: angličtina
Zdroj: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2024 Jan; Vol. 43 (1), pp. 111-119. Date of Electronic Publication: 2023 Sep 04.
DOI: 10.1016/j.healun.2023.08.022
Abstrakt: Background: Pump thrombosis (PT) and related adverse complications contributed to the HeartWare Ventricular Assist Device (HVAD) market withdrawal. Many patients still receive lifelong support, with deficient PT surveillance based on pump power trends. Analysis of pump vibrations is better for detecting PT. Here, we investigated the feasibility of an extracorporeal accelerometer to detect PT from pump vibrations propagated out on the driveline.
Methods: In a porcine HVAD model (n = 6), an accelerometer was attached to the pump as a reference and another to the driveline for comparisons of signals. In total, 59 thrombi were injected into the heart to induce PT, followed by intermittent thrombus washout maneuvers. Signals were compared visually in spectrograms and quantitatively in third harmonic saliences (S 3H ) by correlation analysis. Receiver operating characteristic curves expressed the method's outcome in sensitivity vs specificity, with the overall diagnostic performance in the area under the curve (AUC) score.
Results: Five experiments had good driveline signal strength, with clear spectrographic relationships between the 2 accelerometers. Third harmonic driveline vibrations were visible 20 vs 30 times in the reference. The comparison in S 3H showed a strong correlation and yielded an AUC of 0.85. Notably, S 3H proved robust regarding noise and false PT detections.
Conclusions: An extracorporeal accelerometer on the driveline can be a readily available method for accurate HVAD PT detection before an accelerometer integration with left ventricular assist device is feasible.
(Copyright © 2023 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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