Correlation between the angle of outflow graft to ascending aorta in the left ventricular assist device patients

AIM: End stage heart failure is an increasingly common disease in parallel with increased survival in the population presenting with dispnea, fatigue, and perspiration with high mortality and morbidity. Contemporary treatment comprise of heart failure medication, hospitalization for administration of inotropic agents and mechanical circulatory support. Mechanical circulatory support devices, with the aim of prolonging survival and improving quality of life post-discharge, present themselves as left ventircular assist devices (LVAD) in contemporary daily heart failurepractice. While evidence for prolonged survival and increased functional capacity with the aid of such devices is abundant, they are also associated with a number of adverse events. An event of thrombosis within the pump element of the device is one such event. This study aims to enlighten whether surgical strategy on outflow graft angulation to ascending aorta could decrease occurence and rate of pump thrombosis. MATERIALS AND METHOD: The study includes 109 patients who have undergone LVAD implantation and had a thoracic CT anjiography for any indication. With 3 dimensional reconstruction, angle between the outflow graft and ascending aorta is measured on sagittal and transverse planes, and resultant 3 dimensional angle is calculated. RESULTS: No statistically signification correlation has been found between angulation on sagittal (p=0.35), transverse (p=0.35), or 3 dimensionally recontructed (p=0.53) angles and pump thrombosis occurence or rate. Of note, no statistically significant correlation has been elucidated between LVAD support duration and rate of pump thrombosis either (p=0.11). CONCLUSION: Despite the evidence on the importance of outflow graft angulation with the ascending aorta in the studies employing computational simulations, real clinical data did not yield a statistically significant difference between patients with or without pump thrombosis event. In a patient presenting with pump thrombosis, reasons other than outflow graft angulation may have to be considered for definitive treatment.