Abstract
The ideal position for the orifice of the inflow cannula of a ventricular assist device (VAD) is in the center of the ventricular cavity, because this position allows unrestricted flow into the VAD. In contrast, if the cannula tip rests on the ventricular septum or papillary muscle, flow restriction to the VAD, ventricular arrhythmias, or both, may result. Therefore, properly positioning the inflow cannula during VAD implantation is important. We have found that placing the inflow cannula through the diaphragmatic region of the left ventricle, rather than more apically, usually results in better positioning of the cannula, keeping it away from the ventricular septum. Transesophageal echocardiography can help confirm that the cannula is in proper alignment. Occasionally, the position of the cannula shifts during the postoperative period as a result of mechanical factors or hypovolemia. If flow to the VAD is severely restricted, reoperation to reposition the cannula may be necessary. Shiose and colleagues [1Shiose A. Kim H.I. Takaseya T. et al.Performance of extracorporeally adjustable ventricular assist inflow cannula.Ann Thorac Surg. 2010; 90: 1682-1687Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar] have designed an inflow cannula that can be adjusted extracorporeally by using cables attached to the cannula. The authors achieved a maximum of ±15-degree mobility in a short-term calf model, and the cannula performed well. Flows could be increased or decreased by changing the position of the cannula. If similar results can be achieved in long-term animal studies, this technology may significantly improve VAD design, assuming that it can be adapted to currently used VADs. One drawback of the current design is the need to have the steering cables exit the skin separately. The more hardware that exits through the skin, the higher the risk of infection. The authors have indicated they are designing detachable cables that could be removed once the optimal cannula position has been achieved. Performance of Extracorporeally Adjustable Ventricular Assist Device Inflow CannulaThe Annals of Thoracic SurgeryVol. 90Issue 5PreviewThis study evaluated the feasibility and efficacy of a newly developed adjustable left ventricular assist device inflow cannula in a short-term calf model. Full-Text PDF
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