Preoperative anatomical landmarks and longitudinal HeartMate 3 pump position in X-rays: Relevance for adverse events.

Autor: Widhalm G; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Aigner P; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Gruber B; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Moscato F; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria.; Austrian Cluster for Tissue Regeneration, Vienna, Austria., Moayedifar R; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Schaefer AK; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Dimitrov K; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Zimpfer D; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Riebandt J; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Schlöglhofer T; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria.
Jazyk: angličtina
Zdroj: Artificial organs [Artif Organs] 2024 Aug 06. Date of Electronic Publication: 2024 Aug 06.
DOI: 10.1111/aor.14837
Abstrakt: Background: 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.
Methods: 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).
Results: 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).
Conclusion: 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.
(© 2024 The Author(s). Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
Databáze: MEDLINE
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