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CLINICAL RESEARCH: VENTRICULAR ASSIST DEVICES

Left Ventricular Assist Device Malfunction

An Approach to Diagnosis by Echocardiography

Steven C. Horton, MD, FACC^,,_*, Reza Khodaverdian, MD_^*, Peter Chatelain, BS RDCS, Marsha L. McIntosh, RDCS, Benjamin D. Horne, MStat, MPH_^*, Joseph B. Muhlestein, MD^, and James W. Long, MD, PhD^_*,

^_* Division of Utah Artificial Heart Program, Salt Lake City, Utah
Department of Cardiology, LDS Hospital, Salt Lake City, Utah
University of Utah School of Medicine, Salt Lake City, Utah.

Manuscript received September 19, 2004; revised manuscript received January 1, 2005, accepted January 11, 2005.

^_* Reprint requests and correspondence: Dr. Steven C. Horton, 324 10th Avenue, Suite 206, Salt Lake City, Utah 84103. (Email: schorton{at}msn.com).

OBJECTIVES: A protocol using transthoracic echocardiography was designed to diagnose the common malfunctions of patients on chronic support with a left ventricular assist device (LVAD).

BACKGROUND: Mechanical circulatory support, primarily with a LVAD, is increasingly used for treatment of advanced heart failure as a bridge to transplant and for long-term treatment of heart failure. The LVAD dysfunction is a recognized complication. To date, no studies have defined the role of transthoracic echocardiography in evaluating long-term mechanical complications of chronic LVAD support.

METHODS: Transthoracic echocardiography was used in a protocol designed to detect the common types of mechanical malfunction. Patients were followed up with serial echocardiograms, and clinical validations were made with findings from a catheter-based protocol and inspection at the time of cardiac transplant or corrective surgery.

RESULTS: Thirty-two patients with 44 LVADs were followed up during a four-year period using this protocol that correctly identified 11 patients with inflow valve regurgitation, 2 with intermittent inflow conduit obstruction, 1 with severe kinking of the outflow graft, and 9 with new insufficiency of the native aortic valve.

CONCLUSIONS: As LVAD use for end-stage heart failure becomes widespread, and durations of support are extended, dysfunction will be increasingly prevalent. Transthoracic echocardiography provides a practical method to accurately identify the causes of mechanical dysfunction with patients on chronic LVAD support.

Abbreviations and Acronyms   IVR = inflow valve regurgitation   LV = left ventricle   LVAD = left ventricular assist device   REMATCH = Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure   TEE = transesophageal echocardiography   TTE = transthoracic echocardiography   VTI = velocity time integral

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