Trans-atrial Inflow Cannula Configuration for Durable HeartWare Left Ventricular Assist Device in Hypertrophic Cardiomyopathy: A Case Series and a Word of Caution
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.007 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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 source (direct Gemma or distilled Codex), 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".