LVAD Outflow Research Articles

(216) - HeartMate 3 LVAD Outflow Graft Velocity Profile as Simplified Marker for Left Ventricular Unloading in Echocardiographic Speed Ramp Tests

(216) - HeartMate 3 LVAD Outflow Graft Velocity Profile as Simplified Marker for Left Ventricular Unloading in Echocardiographic Speed Ramp Tests

(1191) - A Novel Indication for TAVR: Targeting Aortic Stenosis in a Patient with LVAD Outflow Graft Obstruction

(1191) - A Novel Indication for TAVR: Targeting Aortic Stenosis in a Patient with LVAD Outflow Graft Obstruction

CARC11: Outcomes of outflow graft stenting in HeartMate 3 left ventricular assist devices: A systematic review

Background: Outflow graft stenosis in continuous-flow left ventricular assist devices (CF-LVAD) is multifactorial. We sought to pool the existing evidence on indications, utilization patterns, and outcomes of transcatheter interventions for outflow graft stenosis in the HeartMate 3 (HM 3) LVAD. Methods: An electronic search was performed to identify all studies in the English literature reporting on HM 3 LVAD outflow graft stenting. Sixteen published reports and one unpublished case comprising a total of 28 patients were included. Patient-level data were extracted for analysis. Results: Median patient age was 68.5 years [Interquartile range: 58, 71] and 25.9% (7/27) were female. Dyspnea [60.7% (17/28)] was the most common presenting symptom. Low flow alarms were present in 60% (15/25) of patients, of which 20% (3/15) did not report other symptoms. LVAD findings included external compression [35.7 % (10/28)], graft twist [21.4% (6/28)], graft twist and external compression [14.3% (4.28)], intravascular thrombus [10.7% (3/28)], graft twist and intravascular thrombus [3.6% (1/28)], and pseudoaneurysm of outflow graft [3.6% (1/28)]. Median time from LVAD implantation to stenting was 2.1 years [1.4, 3] with 35.7% (10/28) receiving two stents and 14.3% (4/28) receiving >2 stents. Immediate flow normalization after stenting was observed in 85.7% (24/28). Recurrent stenosis was observed in 8% (2/25). Other complications included neurological events [8% (2/25)], recurrent low flow alarms [8% (2/25)], and severe right ventricular failure [8% (2/25)]. Heart transplantation was performed in 8% (2/25) after stenting. The 30-day mortality was 12% (3/25). Overall mortality was also 12% (3/25) at a median follow-up of 3.9 months [1, 17]. Conclusion: Outflow graft stenting in HM 3 LVAD appears to be a reasonable treatment option for outflow graft stenosis with low overall rate of complications and mortality. Further refinement of indications and approach may improve outcomes.

(966) Computational Fluid Dynamics as a Surgical Tool to Optimise the Positioning of the LVAD Outflow Graft for Reducing Aortic Regurgitation

(966) Computational Fluid Dynamics as a Surgical Tool to Optimise the Positioning of the LVAD Outflow Graft for Reducing Aortic Regurgitation

Three-Dimensional CT Reconstruction for Diagnosis of LVAD Outflow Graft Twist

<h3>Introduction</h3> Third generation LVAD, HeartMate3 (HM3) are associated with favorable prognosis. A rare life-threatening adverse event is a sudden outflow graft obstruction due to a rotational twist. There is limited data regarding the natural history of this complication. <h3>Case Report</h3> A 70-year-old male with dilated cardiomyopathy was implanted with an HM3 LVAD on September 2019. Echocardiography and cardiac CT immediately following the implantation showed appropriate left ventricular (LV) unloading and normal outflow cannula flows and patency. On April 2021 the patient complained of weakness. Clinical examination was normal, but LVAD interrogation identified decline of LVAD flow. Laboratory tests revealed INR in therapeutic range and normal LDH. An echocardiography revealed impaired unloading of the LV and opening of the aortic valve. A CTA showed a large irregular filling defect sized 7cm at the proximal outflow cannula. Differential diagnosis included outflow cannula twist or thrombosis. Three-dimensional CT volume rendering demonstrated a full rotational twist of the outflow cannula. An untwist operation using a lateral thoracotomy approach identified a >270º twist of the outflow graft. The cannula was untwisted and using a fixation device, the cannula was fixed, resulting in immediate improvement of the flow rate. Repeated transient low flow events at the end of the procedure mandated a repeat CTA to confirm the adequacy of cannula untwisting. Four months following the untwist procedure, the patient is well with stable LVAD flows. <h3>Summary</h3> This is the first case of an outflow graft twist obstruction with comprehensive CTA imaging at 3 critical time points: immediately after LVAD implantation, at twist occurrence and after surgical repair. We believe that it is very important to maintain a high degree of active awareness that a sudden drop in pump flow without signs of pump thrombosis may indicate outflow graft obstruction due to a twist, which is best recognized by three-dimensional CT reconstruction of the outflow graft.

Abstract 13317: Optimization of Left Ventricular Assist Device Therapy: A Combined in vitro and in silico Strategy to Reduce Thromboembolic Adverse Events via Evidence-Based Surgical Configuration and Medical Management

Introduction: Left Ventricular Assist Devices are growing in frequency and importance in the treatment of medical-refractory heart failure. The incidence of thromboembolic events is a principal cause of mortality and morbidity for these patients, despite third generation pumps greatly reducing in-pump thrombosis. Hypothesis: To understand this problem, we hypothesize that LVAD-induced hemodynamics precondition platelets to activate and aggregate, leading to incipient thrombus formation which may propagate throughout the circulation, explaining the high incidence of thromboembolic events in the absence of in-pump thrombosis. Methods: A combined computational and in vitro modeling approach is used to simulate blood flow in the left ventricle, LVAD inflow cannula, outflow graft and aortic arch, with the goal of understanding the role of LVAD therapy in hemodynamics. Results: A systematic optimization of surgical parameters (inflow cannula angle, inflow cannula insertion depth, outflow graft anastomosis angle, outflow graft diameter) and medical management (LVAD speed, blood pressure, aortic valve opening frequency) based on Lagrangian metrics confirmed that the thrombogenicity of LVAD therapy can be potentially be significantly reduced. These metrics allow for quantitative comparisons of device management. Guidelines of optimum ranges of therapy configurations, and definition of “high risk” surgical configurations to avoid have been proposed. Conclusions: Reducing thrombogenicity and improving hemocompatibility is the next frontier in durable LVAD therapy for advanced heart failure. Risk-benefit analysis of many surgical configurations and medical management strategies can be quantitatively analyzed. Systematic analysis can serve as the rationale for future clinical trials that will optimize patient outcomes and reduce complications.

Long-Term Outcomes in Ventricular Assist Device Outflow Cannula Anastomosis to the Descending Aorta

BackgroundLeft ventricular assist device (LVAD) implantation via thoracotomy with outflow cannula anastomosis to the descending aorta is an alternative implantation technique that uses a single incision and avoids anterior mediastinal planes. We evaluated long-term survival and hospital readmissions after LVAD implantation via thoracotomy with outflow cannula anastomosis to the descending aorta. MethodsAdult patients implanted with a continuous flow centrifugal LVAD at an academic center were retrospectively analyzed. Patients were assigned to 1 of 2 cohorts based on the anastomosis site of the LVAD outflow cannula: ascending aorta cohort (Asc-Ao) and descending aorta cohort (Desc-Ao). Primary and secondary outcomes were survival and hospital readmissions during device support. Readmission analysis included patients with ≥30-day survival after discharge. Multivariable analysis and propensity score matching were performed. ResultsSurvival analysis included 330 patients (Asc-Ao: 272, Desc-Ao: 58). Readmission analysis included 277 patients (Asc-Ao: 231, Desc-Ao: 46) and a total of 1028 readmissions during 654 patient-years of follow-up were analyzed. There was no significant difference in in-hospital, 6-month, 1-year, 3-year, and 5-year mortality between the two cohorts. Readmission-free survival, 30-day readmission, number of admissions per year and hospital length of stay per year were not significantly different between the 2 cohorts after adjustment for patient characteristics. ConclusionsThis study found no difference in long-term survival or hospital readmissions between LVAD implantation via thoracotomy with outflow cannula anastomosis to the descending aorta and standard implantation.

Left Ventricular Assist Device Graft Obstruction Relieved by Transcutaneous Stenting in a Teenage Patient

<h3>Introduction</h3> We describe a case of LVAD outflow graft stenosis from external outflow graft compression in a teenage patient successfully treated with percutaneous stenting. <h3>Case Report</h3> 17-year-old female with a continuous flow left ventricular assist device implanted 3 years prior for heart failure secondary to cardiomyopathy due to a TTN gene mutation. She presented with 1 week of worsening shortness of breath and 3 kilogram weight gain. LVAD flows were 3 liters-per-minute (L/min). The patient was referred for transcatheter stent therapy due to concern for outflow cannula obstruction. Hemodynamics during initial catheterization showed a gradient of 30 mmHg across the conduit. A stent was deployed in the distal aspect of the outflow cannula. A second stent was placed to reinforce the area of persistent stenosis. Post-intervention hemodynamics showed an improvement in the gradient to 13 mmHg. She re-presented 3 months later due to LVAD low flow alarm, decreased flows to 0.3 L/min, and decreased wattage of 2.9 watts (Figure 1). CT angiography (CTA) demonstrated 80% narrowing of the outflow conduit, proximal to previously placed outflow graft stents (Figure 2a-b). Low density material between the outflow graft and circumferential wrap was identified by radiology. The previously placed stents were first re-dilated. Three additional stents were placed within the LVAD outflow cannula. We placed the stents from aortic end toward LVAD inflow. In total, the outflow graft was stented for a length of approximately 7.5cm (Figure 3). Angiography showed mild residual narrowing at the anastomotic site. LVAD flows improved to 3.5L/min. Repeat CTA showed no residual evidence of stenosis. <h3>Summary</h3> To our knowledge this is the first reported case of external compression of an LVAD outflow graft from an overwrap treated with successful transcatheter stent treatment in the pediatric population. By stenting the outflow graft we believe we pushed the built-up material into the mediastinum, relieving the obstruction.

Dynamic LVAD Inflow Cannula Obstruction Due to Mobile Thrombi

<h3>Introduction</h3> While LVAD outflow cannula obstructions are commonly described, we present a rare case of fulminant heart failure secondary to dynamic inflow cannula obstruction due to mobile thrombi within the left ventricular cavity. <h3>Case Report</h3> A 65 year old man with a history of ischemic cardiomyopathy and chronic kidney disease (CKD) underwent implantation of a continuous flow left ventricular assist device (LVAD; HeartWare™ HVAD™, Medtronic plc) as a bridge to transplantation. Three years following implantation, he presented with progressive fulminant right heart failure (RHF) followed by a sudden decrease in LVAD flow from 3.5 to 1.5 liters/min (Figure 1A). INR was 2.6, lactate dehydrogenase (LDH) level was normal and transthoracic echocardiogram showed a midline septum and the aortic valve opening with every beat. On admission, flows did not improve despite inotropic support. Outflow graft obstruction was suspected, however imaging was not pursued due to the risk of further renal injury with intravenous contrast, and that ultimately definitive treatment strategy remained heart transplantation. His UNOS listing status was upgraded from 4 to 2E. Anticoagulation was not escalated beyond aspirin and warfarin due to recurrent gastrointestinal bleeding. He continued to experience recurrent abrupt changes in LVAD flows (Figure 1B) without additional evidence to support pump thrombosis. Five weeks later, at the time of heart-kidney transplant, a partially obstructive thrombus within the inflow cannula as well as a mobile thrombus attached to the endocardium, prolapsing intermittently into the inflow cannula were visualized (Figure 1C-1D). <h3>Summary</h3> Dynamic inflow cannula obstruction should be suspected in the setting of heart failure and sudden changes in LVAD pump power consumption even when a lack corroborating imaging and laboratory evidence exists.

Diagnosis and Treatment Strategies of Outflow Graft Obstruction in the Fully Magnetically Levitated Continuous-Flow Centrifugal Left Ventricular Assist Device - A Multicenter Case Series

Reports of pump thrombosis are less common for the HeartMate 3 than for other commercially available LVAD. However, blood flow obstructions of the inflow and especially of the outflow graft are likely to occur also with this device. A correct diagnosis is crucial for optimal treatment to ultimately avoid bail-out by (urgent) heart transplantation or unwarranted pump exchange. We present six cases of outflow graft obstruction (OGO) other than twist of the outflow graft under oral anticoagulation. We present detection principles and discuss treatment strategies. 1: 64 y/o, female, valvular heart disease, 21 months after implantation, presentation with multiple low-flow alarms. 50% OGO in CT scan. External cannula compression proximal of the LVAD outflow conduit in percutaneous angiography (PA). Re-thoracotomy, opening of the bend relief made of a reinforced PTFE graft, removement of hyaline thrombus, pump flow returned to normal. 2: 70 y/o, female, dilated CMP, recurrent low-flow alarms, high PI values. Consistently low flow in ramp study. Treatment of severe OGO in PA with two stents. Pump flow returned to normal. 3: 55 y/o, male. Presentation of acute angina pectoris, dyspnea. 75% OGO in CT scan. PA and implantation of two stents. Relief from clinical symptoms. 4: 37 y/o male, dilated CMP. Routinely admission for evaluation for heart transplantation (HTx). LVAD log files normal. Significant OGO in CT scan. PA confirmed OGO, but no relevant gradient pressure across the outflow graft, decision to "watchful waiting approach" and listing for HTx. 5: 67 y/o, male, dilated CMP. Presentation in a reduced general condition and slightly reduced pump flow. 70% OGO in CT scan. Pump flow increased to normal after intervention. 6: 56 y/o, female, ischemic CMP. Presentation with acute persistent low-flow alarms. 50% OGO in CT scan. Multiple hypodense areas in the infra- and supratentorial region as consequence of an embolic induced ischemic stroke. Despite emergency treatment the patient died on the same day. OGO in LVAD is a rare complication whose clinical presentation may be subtle. Three patients were successfully managed with stents, one underwent surgical revision, one patient died despite emergency treatment and the last patient without symptoms was listed for HTx.

Association of LVAD Cannula Position with Stroke Risk

Stroke remains a major cause of morbidity and mortality in LVAD patients, with incidence upto to 22%. We hypothesized that certain LVAD cannula positions are associated with unfavourable flow patterns resulting in altered thrombogenicity, and therefore higher stroke risk. We conducted a retrospective review of patients that underwent LVAD implantation at our institution from 2011 to 2016. All patients who underwent cardiac CT scan, were included. Patients with non-contrast CT scans, and poor quality imaging data were excluded. We studied imaging data from three modalities: X-ray, Echocardiography and cardiac CT. The primary outcome was defined as stroke within one year of LVAD implantation. A total of 78 patients were included in the study. The predominant device was HeartMate II (94.8%), there were three patients with HVAD and one patient with HeartMate III. Of these, 12 patients had stroke within one year of LVAD implantation: 10 were ischemic and 2 were hemorrhagic. Mean time to stroke was 108 days. There were no significant differences between the two groups with regard to X-ray or Echocardiographic variables. The mean outflow cannula angle in the stroke group was 61.19 degrees, whereas that in the non-stroke cohort was 45.92 degrees. The mean diameter of outflow cannula anastomosis in the stroke group was 1.52 cm whereas that in the non-stroke group was 1.34 cm. Our study was the first to show that LVAD outflow cannula angle and diameter of anastomosis are significantly associated with stroke risk. Therefore, optimization of surgical technique/ engineering methods may help mitigate stroke risk in LVAD patients.

Outflow Graft Obstruction Causing Recurrent Heart Failure after Left Ventricular Assist Device Implantation

Outflow graft obstruction is a poorly described complication following continuous flow-left ventricular assist device (CF-LVAD) surgery. We sought to define the incidence of CF-LVAD outflow graft obstruction and assess clinical outcomes with a percutaneous treatment strategy. From January 2012 to June 2019, 252 CF-LVAD patients were managed at our institution. Patients with suspected LVAD outflow graft obstruction underwent comprehensive evaluation with Doppler echocardiography, cardiac computed tomography with angiography and invasive hemodynamic assessment followed by percutaneous intervention. Fourteen patients (5.6%) developed hemodynamically significant LVAD outflow graft obstruction at a rate of 0.03 events per patient-year. Outflow graft obstruction presented a mean of 34±18 months after surgery. Patients presented with heart failure (HF; 86%), low LVAD pump flow (93%), or both (79%). LVAD flow declined by an average of 2.1±0.8L/min (p<0.001). Outflow graft obstruction was caused by external graft compression (77%), stenosis of the aortic anastomosis (46%) and discrete kinking of the outflow cannula (46%); most patients presented with 2 or more lesions (69%). There were no cases of outflow graft thrombosis. External graft compression was uniformly due to build-up of fibrinous material between the outflow cannula and the protective external GoreTex graft. Outflow graft stenting was 100% successful and reduced the gradient from 80mmHg (IQR 58-100mmHg) to 13mmHg (IQR 10-20mmHg, Figure). There was no in-hospital mortality and few complications. Outflow graft stenting was durable; over a mean follow-up of 13±7 months, no patients had recurrent outflow graft obstruction. LVAD outflow graft obstruction is a relatively common and underappreciated cause of recurrent HF and LVAD dysfunction. Outflow graft stenting can be achieved with low morbidity and provides a long-term solution to this complication.

Incidence, Clinical Relevance and Treatment Options for Outflow Graft Stenosis after LVAD Implantation

LVAD outflow graft stenosis (OGS) is increasingly recognized after left ventricular assist device implantation. We analyzed our institutional experience with (OGS) in order to better understand the clinical significance and treatment options for this new form of pump pathology. We retrospectively reviewed our institutional experience with OGS in patients with contemporary centrifugal LVAD. Study endpoint were incidence and outcomes of LVAD OGS. From March 2006 to October 2019, 284 consecutive patients (183 (64.4%) HVAD and 101 (35.6%) HeartMate3) underwent primary LVAD implantation. Median follow up was 456 (range 1-2921) days. OGS was identified in 17 patients (total incidence 5.0%, 95% CI 3.5%-9.4%; HVAD: 5.5%, 95% CI 2.7%-9.8% vs. HeartMate3 6.9%, 95% CI 2.8%-13.8%, p=0.611). Median time to OGS development was 911 (range 281-2811) days. In all cases, OGS was located within covered segments of the outflow graft (bend relief (Heartmate 3 only) or protective Gore-Tex cover). In 13 patients (76.5%) OGS impaired LVAD flow and necessitated interventions (surgical revision n=2, endovascular stent placement n=9, surgery after failed stent placement n=1, death before intervention n=1). Two patients (11.8%) died following intervention and outflow graft stenosis recurred in two patients (11.8%) after initially successful treatment. Kaplan-Meier estimate of survival free from outflow graft stenosis is depicted on Figure 1. Outflow graft stenosis is a potentially lethal late complication of LVAD implantation. Surgical or interventional treatment is indicated when LVAD flows are impaired. Modification of pump design may be warranted as outflow graft stenosis preferentially occur in covered portions of outflow grafts.

LVAD Outflow Graft Role in Pump Thrombosis.

Left ventricular assist devices are (LVAD) used for circulatory support in patients with end-stage heart failure. Hemolysis/pump dysfunction is a well-known complication of this therapy with various etiologic causes. A small proportion of these complications are caused by outflow graft obstructions; this complication has received little attention in the scientific literature. Herein, we provide a comprehensive overview of the role of the LVAD outflow graft obstruction and its treatment options.

Interventricular septal hematoma complicating placement of a ventricular assist device in an infant and support with bi-atrial cannulation.

Interventricular septal hematoma complicating placement of a ventricular assist device in an infant and support with bi-atrial cannulation.

Aortic Insufficiency is Associated with Hemocompatibility-Related Adverse Events in LVAD Patients

Purpose Hemocompatibility-related clinical adverse events (HRAEs) are major causes of readmission and reduce quality of life in LVAD patients. The impact of aortic insufficiency (AI) on HRAEs remains uncertain. This study assessed the impact of AI, which was graded by using novel Doppler echocardiographic parameters obtained at the LVAD outflow cannula , on HRAEs. Methods LVAD patients with varying degrees of AI underwent Doppler echocardiography of the LVAD outflow cannula. AI regurgitation fraction (RF) was calculated from the systolic/diastolic velocity ratio and the rate of diastolic flow acceleration of the LVAD outflow cannula (Figure 1A). RF >30% defined as significant AI. Freedom from any HRAEs and the net burden of HRAEs, which was calculated by using a hemocompatibility score (with 4 escalating tiers of hierarchal severity), were compared between those with/without significant AI during a 1-year observational period. Results Among 105 patients (median age 56 years, 76% male), 36 patients (34%) had significant AI. Baseline characteristics were comparable between two groups (p >0.05 for all). One-year survival free from HRAEs was 44% in the significant AI group compared with 67% in the non-significant AI group (p = 0.018; Figure 1B). The average hemocompatibility score in the significant AI group was higher compared with the non-significant AI group (1.72 vs. 0.64; p = 0.009; Figure 1C), due to higher tier I (gastrointestinal bleedings or medically managed pump thrombosis ; p = 0.034) and tier IIIB scores (HRAE-related death; p = 0.011). Conclusion Significant AI, which was assessed by using novel Doppler echocardiographic parameters, was associated with an increased rate of HRAEs in LVAD patients.

The hemodynamic effects of the LVAD outflow cannula location on the thrombi distribution in the aorta: A primary numerical study

Although a growing number of patients undergo LVAD implantation for heart failure treatment, thrombi are still the devastating complication for patients who used LVAD. LVAD outflow cannula location and thrombi generation sources were hypothesized to affect the thrombi distribution in the aorta. To test this hypothesis, numerical studies were conducted by using computational fluid dynamic (CFD) theory. Two anastomotic configurations, in which the LVAD outflow cannula is anastomosed to the anterior and lateral ascending aortic wall (named as anterior configurations and lateral configurations, respectively), are designed. The particles, whose sized are same as those of thrombi, are released at the LVAD output cannula and the aortic valve (named as thrombiP and thrombiL, respectively) to calculate the distribution of thrombi. The simulation results demonstrate that the thrombi distribution in the aorta is significantly affected by the LVAD outflow cannula location. In anterior configuration, the thrombi probability of entering into the three branches is 23.60%, while that in lateral configuration is 36.68%. Similarly, in anterior configuration, the thrombi probabilities of entering into brachiocephalic artery, left common carotid artery and left subclavian artery, is 8.51%, 9.64%, 5.45%, respectively, while that in lateral configuration it is 11.39%, 3.09%, 22.20% respectively. Moreover, the origins of thrombi could affect their distributions in the aorta. In anterior configuration, the thrombiP has a lower probability to enter into the three branches than thrombiL (12% vs. 25%). In contrast, in lateral configuration, the thrombiP has a higher probability to enter into the three branches than thrombiL (47% vs. 35%). In brief, the LVAD outflow cannula location significantly affects the distribution of thrombi in the aorta. Thus, in the clinical practice, the selection of outflow location of LVAD and the risk of thrombi formed in the left ventricle should be paid more attention than before.

Novel echocardiographic parameters of aortic insufficiency in continuous-flow left ventricular assist devices and clinical outcome

The aim of this study was to evaluate the prognostic performance of novel echocardiographic (transthoracic echocardiography, or TTE) parameters for grading aortic insufficiency (AI) severity in patients with continuous-flow left ventricular assist devices (CF-LVADs). The development of AI after CF-LVAD implantation is common, although the clinical significance remains unclear. We previously described novel TTE parameters that outperformed traditional TTE parameters in grading AI severity in these patients. CF-LVAD patients with varying degrees of AI (N = 57) underwent Doppler TTE of the LVAD outflow cannula. Patients had AI severity graded by the novel parameters (systolic/diastolic velocity ratio and the diastolic acceleration of the LVAD outflow cannula) and the traditional vena contracta. The prognostic performance of novel and traditional AI parameters was determined by comparing rates of congestive heart failure re-admission, need for aortic valve intervention, urgent transplantation and death (composite end-points) for each parameter. Grading AI severity using novel AI parameters led to reclassification of 32% of patients from trace/mild AI to moderate or greater AI (N = 18). Using traditional AI parameters, there was no difference in the occurrence of the composite end-point between the moderate or greater group and the trace/mild group (1.50 vs 1.18 events/person, p = 0.46). With the novel AI parameters, there were significantly more events in the patients with moderate or greater AI compared to those with trace/mild AI (1.57 vs 0.13 events/person, p = 0.002). Novel parameters also better predicted the need for aortic valve intervention, urgent transplantation or death than traditional methods (p = 0.024 vs p = 0.343). In patients with CF-LVADs, traditional parameters tend to underestimate AI severity and future cardiac events. Novel AI TTE parameters are better able to discriminate AI severity and predict clinically meaningful outcomes.

(242) - Micro-Embolic Signals Correlate with Pump Thrombus Formation and Non-Thrombotic Outflow Graft Occlusion in Patients with Left Ventricular Assist Devices

s S97 Methods: From June 2014 to October 2015 LVAD patients were systematically screed for HITS in the LVAD outflow graft by transthoracic echocardiography. The occurrence of HITS was then correlated with pump thrombus formation (PT) and non-thrombotic outflow graft occlusion. Results: HITS were detected in the outflow graft of 18 LVAD patients (Thoratec Heartmate II n= 12, Heartware HVAD n= 6). HITS correlated with PT in 12 patients (Heartmate II n= 7, HVAD n= 5) and non-thrombotic outflow graft stenosis in 6 patients (Heartmate II n= 5, HVAD n= 1). Patients with PT either underwent thrombolysis (n= 5), pump exchange (n= 2), LVAD weaning (n= 1) or no treatment if no hard clinical treatment indication was present (n= 5). In PT patients HITS disappeared after successful thrombolysis or pump exchange. Of note, pump thrombus formation or non-thrombotic outflow graft stenosis could be macroscopically assured at the time of transplant in the remaining patients. Conclusion: HITS detection by transthoracic echocardiography identifies patients with pump thrombus formation and non-thrombotic outflow graft occlusion and might develop as a very sensitive screening tool for pump pathology and hypocoagulation monitoring.

(1066) - LVAD Outflow Cannula Systolic Slope in Patients with Left Ventricular Assist Devices: A Marker of Myocardial Contractility

(1066) - LVAD Outflow Cannula Systolic Slope in Patients with Left Ventricular Assist Devices: A Marker of Myocardial Contractility