Trans-atrial Inflow Cannula Configuration for Durable HeartWare Left Ventricular Assist Device in Hypertrophic Cardiomyopathy: A Case Series and a Word of Caution
Background/objectives: Implantation of a durable left ventricular assist device (LVAD) in patients with hypertrophic cardiomyopathy (HCM) is technically challenging. We describe our experience using a trans-atrial inflow cannulation and a left atrial-to-aorta (LA-Ao) LVAD configuration. Pump hemodyn...
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Elsevier
2025-08-01
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| author | Darshan H. Brahmbhatt, MB BChir, MD Pierre-Emmanuel Noly, MD, PhD Nicole L. Fung, BSc (Hons) Filio Billia, MD, PhD Vivek Rao, MD, PhD Mitesh V. Badiwala, MD, PhD |
| author_facet | Darshan H. Brahmbhatt, MB BChir, MD Pierre-Emmanuel Noly, MD, PhD Nicole L. Fung, BSc (Hons) Filio Billia, MD, PhD Vivek Rao, MD, PhD Mitesh V. Badiwala, MD, PhD |
| author_sort | Darshan H. Brahmbhatt, MB BChir, MD |
| collection | DOAJ |
| description | Background/objectives: Implantation of a durable left ventricular assist device (LVAD) in patients with hypertrophic cardiomyopathy (HCM) is technically challenging. We describe our experience using a trans-atrial inflow cannulation and a left atrial-to-aorta (LA-Ao) LVAD configuration. Pump hemodynamics, selection criteria, technical considerations, and postoperative management reflections are discussed. Methods: Three patients who underwent centrifugal pump implantation using LA-Ao configuration between January 2019 and May 2021 at our institution were reviewed. Patient characteristics, hemodynamics, pump parameters, outcomes are presented. Results: All patients (2 males, 1 female, aged: 40–64 years-old) had end-stage heart failure secondary to HCM and were INTERMACS Profile 3. Two patients were successfully bridged to transplantation after four months of support, and one patient died from pump thrombosis and stroke. Compared with the left ventricle-to aorta (LV-Ao) confirmation, the variations of the pump flow through the cardiac cycle are inversed in the LA-Ao configuration, and the pressure head is higher leading to a reduced pump-flow at a fixed pump speed. The presence of severe bi-atrial enlargement is an important selection criterion. Conclusion: LA-Ao LVAD configuration might be an alternative for durable LVAD implantation in highly selected candidates with small left ventricular cavity. Post-operative management should account for the higher risk of pump thrombosis related to a reduced trans-pump flow in this configuration. |
| format | Article |
| id | doaj-art-c5c2fc31a5ff45ec860115fc43040c6d |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-c5c2fc31a5ff45ec860115fc43040c6d2025-08-20T03:37:31ZengElsevierJHLT Open2950-13342025-08-01910026510.1016/j.jhlto.2025.100265Trans-atrial Inflow Cannula Configuration for Durable HeartWare Left Ventricular Assist Device in Hypertrophic Cardiomyopathy: A Case Series and a Word of CautionDarshan H. Brahmbhatt, MB BChir, MD0Pierre-Emmanuel Noly, MD, PhD1Nicole L. Fung, BSc (Hons)2Filio Billia, MD, PhD3Vivek Rao, MD, PhD4Mitesh V. Badiwala, MD, PhD5Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Cardiology, Mount Sinai Hospital, Sinai Health System, Toronto, ON, CanadaDepartment of Cardiac Surgery, Montreal Heart Institute, University of Montreal, Montreal, QC, CanadaTed Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, CanadaTed Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, CanadaDivision of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, CanadaDepartment of Surgery, University of Toronto, Toronto, ON, Canada; Department of Cardiac Surgery, Heart Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi, UAE; Corresponding author: Dr. Mitesh V. Badiwala, MD, PhD, Cleveland Clinic Abu Dhabi, PO Box 112412, Abu Dhabi, United Arab Emirates.Background/objectives: Implantation of a durable left ventricular assist device (LVAD) in patients with hypertrophic cardiomyopathy (HCM) is technically challenging. We describe our experience using a trans-atrial inflow cannulation and a left atrial-to-aorta (LA-Ao) LVAD configuration. Pump hemodynamics, selection criteria, technical considerations, and postoperative management reflections are discussed. Methods: Three patients who underwent centrifugal pump implantation using LA-Ao configuration between January 2019 and May 2021 at our institution were reviewed. Patient characteristics, hemodynamics, pump parameters, outcomes are presented. Results: All patients (2 males, 1 female, aged: 40–64 years-old) had end-stage heart failure secondary to HCM and were INTERMACS Profile 3. Two patients were successfully bridged to transplantation after four months of support, and one patient died from pump thrombosis and stroke. Compared with the left ventricle-to aorta (LV-Ao) confirmation, the variations of the pump flow through the cardiac cycle are inversed in the LA-Ao configuration, and the pressure head is higher leading to a reduced pump-flow at a fixed pump speed. The presence of severe bi-atrial enlargement is an important selection criterion. Conclusion: LA-Ao LVAD configuration might be an alternative for durable LVAD implantation in highly selected candidates with small left ventricular cavity. Post-operative management should account for the higher risk of pump thrombosis related to a reduced trans-pump flow in this configuration.http://www.sciencedirect.com/science/article/pii/S2950133425000606Left ventricular assist deviceHypertrophic cardiomyopathyHemodynamicsTrans atrial cannulationTerminal heart failure |
| spellingShingle | Darshan H. Brahmbhatt, MB BChir, MD Pierre-Emmanuel Noly, MD, PhD Nicole L. Fung, BSc (Hons) Filio Billia, MD, PhD Vivek Rao, MD, PhD Mitesh V. Badiwala, MD, PhD Trans-atrial Inflow Cannula Configuration for Durable HeartWare Left Ventricular Assist Device in Hypertrophic Cardiomyopathy: A Case Series and a Word of Caution JHLT Open Left ventricular assist device Hypertrophic cardiomyopathy Hemodynamics Trans atrial cannulation Terminal heart failure |
| title | Trans-atrial Inflow Cannula Configuration for Durable HeartWare Left Ventricular Assist Device in Hypertrophic Cardiomyopathy: A Case Series and a Word of Caution |
| title_full | Trans-atrial Inflow Cannula Configuration for Durable HeartWare Left Ventricular Assist Device in Hypertrophic Cardiomyopathy: A Case Series and a Word of Caution |
| title_fullStr | Trans-atrial Inflow Cannula Configuration for Durable HeartWare Left Ventricular Assist Device in Hypertrophic Cardiomyopathy: A Case Series and a Word of Caution |
| title_full_unstemmed | Trans-atrial Inflow Cannula Configuration for Durable HeartWare Left Ventricular Assist Device in Hypertrophic Cardiomyopathy: A Case Series and a Word of Caution |
| title_short | Trans-atrial Inflow Cannula Configuration for Durable HeartWare Left Ventricular Assist Device in Hypertrophic Cardiomyopathy: A Case Series and a Word of Caution |
| title_sort | trans atrial inflow cannula configuration for durable heartware left ventricular assist device in hypertrophic cardiomyopathy a case series and a word of caution |
| topic | Left ventricular assist device Hypertrophic cardiomyopathy Hemodynamics Trans atrial cannulation Terminal heart failure |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425000606 |
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