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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 4, July/August 2016
208
AFRICA
Cardiovascular Topics
Fine-tuning management of the Heart Assist 5 left
ventricular assist device with two- and three-dimensional
echocardiography
Zumrut Tuba Demirozu, Nurcan Arat, Deniz Suha Kucukaksu
Abstract
Introduction:
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.
Methods:
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.
Results:
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
2
, mean cardiac index (CI) was
2.04
±
0.4 (1.5–2.6) l/min/m
2
, mean cardiac output (CO) was
3.7
±
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.
Conclusion:
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.
Keywords:
Heart Assist 5 LVAD, continuous-flow pumps, two-
and three-dimensional echocardiography
Submitted 11/2/15, accepted 14/11/15
Cardiovasc J Afr
2016;
27
: 208–212
www.cvja.co.zaDOI: 10.5830/CVJA-2015-083
Left ventricular assist devices (LVADs) are the accepted treatment
modality for advanced end-stage heart failure patients.
1-5
LVADs
have been reported to be effective therapy in supporting
cardiovascular circulation and end-organ function for weeks
and even years.
1-3
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.
1-7
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,
tdemirozu@yahoo.comDepartment of Cardiology, Istanbul Bilim Medical Faculty,
Sisli Florence Nightingale Hospital, Istanbul, Turkey
Nurcan Arat, MD