The approach to placement of a continuous-flow intracorporeal ventricular assist device in small left ventricle
Bibliographic record
Abstract
Background The HeartMate 3 (HM3) has become among the most widely utilized durable left ventricular (LV) assist devices (LVAD) owing to reduced rates of pump thrombosis, bleeding, and stroke. One limitation of the HM3 is its large size, which poses a challenge for implantation in smaller LVs. Herein, we describe a novel technique for durable LVAD implantation in patients with a small LV. Methods Patients who underwent durable LVAD implantation from January 2020 to August 2024 were included in this study. The modified technique involved excision of the mitral valve (MV) and associated apparatus to create room for the LVAD inflow. The primary outcome was mortality, and secondary outcomes included rates of postoperative complications and hemodynamic parameters. Patient follow-up was until September 2024. Results Eleven patients were included in this study. All patients received an HM3. The median preoperative LV end-diastolic diameter was 5.1 cm. The median total time on LVAD was 149 days, and overall mortality was 27.2% occurring a median of 204 days post-LVAD implantation. Four patients (36.4%) underwent heart transplantation and 4 (36.4%) were alive on LVAD at last follow-up. Proportions of morbidity included readmission for heart failure ( n = 2, 18.2%), cerebrovascular accident ( n = 2, 18.2%), and pump thrombosis ( n = 0). Conclusions The small LV has been a significant challenge for durable LVAD insertion and is often considered a contraindication. A modified approach to LVAD insertion, including excision of the MV and associated apparatus and alignment of the LVAD inflow cannula with the MV orifice, allows for LVAD implantation in patients with a small LV.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".