Clinical dilemma
Presentation and management of left ventricular assist device inflow cannula malposition

https://doi.org/10.1016/j.healun.2011.03.003Get rights and content

An unusual problem associated with the use of left ventricular assist devices (LVADs) relates to malposition of the apical inflow cannula. From 2005 to 2010, we implanted 154 continuous-flow HeartMate II (Thoratec, Pleasanton, CA) LVADs at our institution. In 4 separate instances, patients appeared to have malposition of the inflow cannula that resulted in serious symptoms. All 4 patients underwent surgery to reposition the cannula. Successful outcomes were achieved for 3 of the 4 patients.

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Patient 1

A 69-year-old man with non-ischemic cardiomyopathy and progressive heart failure was not considered an optimal candidate for cardiac transplantation because of advanced age and obesity, He underwent elective placement of a HeartMate II LVAD as destination therapy. His early post-operative course was remarkable for pulmonary edema and respiratory failure that prevented extubation. Swan-Ganz catheter evaluation revealed persistent elevation of pulmonary artery pressures despite progressive

Discussion

With continuous-flow LVAD placement, the apical cannula position may be dynamic. Significant obstruction of the apical cannula by the septum or the lateral wall occurred in 4 of 154 implants in this review. Clinical presentations were distinct and included failure to achieve LV unloading, as demonstrated by invasive monitoring, syncope presumably from intermittent obstruction and low output, intractable ventricular arrhythmias, and recurrent severe hemolysis. In one instance, symptoms were

Disclosure statement

Drs Carmelo Milano and Joseph Rogers have served as consultants and have received research grants from Thoratec Inc. None of the other authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.

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