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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 4, July/August 2016



Cardiovascular Topics

Fine-tuning management of the Heart Assist 5 left

ventricular assist device with two- and three-dimensional


Zumrut Tuba Demirozu, Nurcan Arat, Deniz Suha Kucukaksu



Left ventricular assist device (LVAD) implan-

tation is a viable therapy for patients with severe end-stage

heart failure, providing effective haemodynamic support

and improved quality of life. The Heart Assist 5 (Micromed

Cardiovascular Inc, Houston, TX) continuous-flow LVAD

has been on the market in Europe since May 2009.


We evaluated nine Heart Assist 5 LVAD patients

with two- and three-dimensional transthoracic echocardio-

graphic (TTE) and transoesophageal echocardiographic

(TEE) parameters between December 2011 and December

2013. The pre-operative TTE LVAD evaluations included left

ventricular (LV) function and structure, quantification of right

ventricular (RV) function and tricuspid regurgitation (TR),

assessment of aortic and mitral regurgitation, and presence

of patent foramen ovale and intra-cardiac clots. Peri-operative

TEE determined the inflow cannula and septum position, and

assessed the de-airing process while weaning from cardiopul-

monary bypass. Post-operative serial follow-up TTE showed

the surgical results of LVAD implantation, determined the

overall structure and function of the LV, RV and TR, and

observed the inflow and outflow cannula position.


Nine patients who had undergone Heart Assist 5

LVAD implantation and had been followed up for more

than 30 days were included in this study. Eight patients had

ischaemic cardiomyopathy and one had adriamycin-induced

cardiomyopathy. Pre-implantation data: the mean age of the

patients was 52


13 (34–64) years, mean body surface area

(BSA) was 1.8


0.2 (1.6–2.0) m


, mean cardiac index (CI) was



0.4 (1.5–2.6) l/min/m


, mean cardiac output (CO) was



0.7 (2.6–4.2) l/min, mean ejection fraction (EF) was 23


5 (18–28)%, and right ventricular fractional area contraction

(RVFAC) was 43


9 (35–55)%.

One patient had aortic valve replacement (AVR) during

the LVAD implantation, and excess current alarms and

increased power were suspected to be caused by a possible

thrombus. Close follow up with TTE studies were carried

out to clear the LV of thrombus formation, and the inflow

cannula position was checked to maintain the septum in the

midline, so preventing the suction cascade. Four patients

were followed up for more than two years, and two were

followed up for more than a year. Three patients died due

to multi-organ failure. Follow-up speed-change TTE stud-

ies of six patients showed that the mean speed was 9 800


600 (9 500–10 400) rpm, and mean CO was 4.7


0.3 (4.3–

5.0) l/min during the three-month post-implant period.


We believe that TTE can play a major role in

managing LVAD patients to achieve optimal settings for each

patient. A large series is mandatory for assessment of echo-

cardiographic studies on Heart Assist 5 LVAD.


Heart Assist 5 LVAD, continuous-flow pumps, two-

and three-dimensional echocardiography

Submitted 11/2/15, accepted 14/11/15

Cardiovasc J Afr



: 208–212

DOI: 10.5830/CVJA-2015-083

Left ventricular assist devices (LVADs) are the accepted treatment

modality for advanced end-stage heart failure patients.



have been reported to be effective therapy in supporting

cardiovascular circulation and end-organ function for weeks

and even years.


Increased use of LVAD therapy for patients

with advanced heart failure has revealed a new paradigm for this

novel physiology.

It has been reported that there is a knowledge gap on these

new-generation, continuous-flow pumps and their effect on

cardiac and end-organ physiology. There is a growing need for

practising heart failure cardiologists and transplant surgeons

who take care of these patients to evaluate the pumps and their

effects in patients.


Monitoring, tracking and management of

these patients needs experience so that the pumps work more

efficiently with minor side effects and complications.

Echocardiography is the most important non-invasive

imaging tool for LVAD assessment at pre-, peri- and post-

Department of Heart Transplant and Mechanical

Circulatory Support, Istanbul Bilim Medical Faculty, Sisli

Florence Nightingale Hospital, Istanbul, Turkey

Zumrut Tuba Demirozu, MD

Deniz Suha Kucukaksu, MD

Department of Cardiovascular Surgery, Koc University

Hospital, Istanbul, Turkey

Zumrut Tuba Demirozu, MD,

Department of Cardiology, Istanbul Bilim Medical Faculty,

Sisli Florence Nightingale Hospital, Istanbul, Turkey

Nurcan Arat, MD