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Mechanical Circulatory Assist Devices
Jinglei Li, MD; John P. Lichtenberger, III, MD; Sachin Saboo, MD, FRCR
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KEY FACTS

  • Terminology

    • Imaging Anatomy

      • Anatomy-based Imaging Issues

        • Pathology-based Imaging Issues

          • Clinical Implications

            • Post-Procedure Complications

              TERMINOLOGY

              • Abbreviations

                • Left ventricular assist device (LVAD)
                • Right ventricular assist device (RVAD)
                • Biventricular assist device (BiVAD)
                • Percutaneous ventricular assist device (pVAD)
                • Intraaortic balloon pump (IABP)
                • Total artificial hearts (TAH)
              • Definitions

                • Mechanical pump device used to augment cardiac output for failing ventricle
                  • LVAD goal
                    • Diverting oxygenated blood from left heart into aorta, bypassing left ventricular function
                  • RVAD goal
                    • Diverting blood from right ventricle to pulmonary artery, bypassing right ventricular function
                • FDA approval of 1st LVAD as bridge to transplant was in 1994
                  • Heartmate II, III and HVAD devices are only commercially FDA-approved adult ventricular assist device (VAD) options in North America
                  • SynCardia TAH is only FDA-approved device in its class 
                • Impella goal
                  • Transfer oxygenated blood via catheter tip in left ventricle to outlet in ascending aorta by axial flow

              IMAGING ANATOMY

              • General Anatomic Considerations

                PATHOLOGY-BASED IMAGING ISSUES

                • Key Concepts

                  CLINICAL IMPLICATIONS

                  • Clinical Importance

                    • Indications

                      • Contraindications

                        • Best Procedure Approach

                          • Imaging Findings

                            • Imaging Protocols

                              • Imaging Pitfalls

                                Equipment

                                • Types

                                  • Components

                                    • Devices

                                      Post Procedure

                                      • Expected Outcome

                                        • Complications

                                          Selected References

                                          1. Dandel M et al: Temporary assist device support for the right ventricle: pre-implant and post-implant challenges. Heart Fail Rev. 23(2):157-71, 2018
                                          2. Han JJ et al: Left ventricular assist devices. Circulation. 138(24):2841-51, 2018
                                          3. Hanke JS et al: One-year outcomes with the HeartMate 3 left ventricular assist device. J Thorac Cardiovasc Surg. 156(2):662-9, 2018
                                          4. Saeed D: Right ventricular failure and biventricular support strategies. Cardiol Clin. 36(4):599-607, 2018
                                          5. Brixey AG et al: Innovative cardiac devices on chest imaging: an update. J Thorac Imaging. 32(6):343-57, 2017
                                          6. DeVore AD et al: Medical management of patients with a left ventricular assist device for the non-left ventricular assist device specialist. JACC Heart Fail. 5(9):621-31, 2017
                                          7. Mohamed I et al: Building a bridge to save a failing ventricle: radiologic evaluation of short- and long-term cardiac assist devices. Radiographics. 35(2):327-56, 2015
                                          8. Mellnick VM et al: Imaging of left ventricular device complications. J Thorac Imaging. 28(2):W35-41, 2013
                                          9. Mishkin JD et al: Utilization of cardiac computed tomography angiography for the diagnosis of left ventricular assist device thrombosis. Circ Heart Fail. 5(2):e27-9, 2012
                                          10. Bolen MA et al: Left ventricular assist device malposition interrogated by 4-D cine computed tomography. J Cardiovasc Comput Tomogr. 5(3):186-8, 2011
                                          11. Kar B et al: The percutaneous ventricular assist device in severe refractory cardiogenic shock. J Am Coll Cardiol. 57(6):688-96, 2011
                                          12. Carr CM et al: CT of left ventricular assist devices. Radiographics. 30(2):429-44, 2010
                                          13. Estep JD et al: The role of echocardiography and other imaging modalities in patients with left ventricular assist devices. JACC Cardiovasc Imaging. 3(10):1049-64, 2010
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging Anatomy

                                              • Anatomy-based Imaging Issues

                                                • Pathology-based Imaging Issues

                                                  • Clinical Implications

                                                    • Post-Procedure Complications

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Left ventricular assist device (LVAD)
                                                        • Right ventricular assist device (RVAD)
                                                        • Biventricular assist device (BiVAD)
                                                        • Percutaneous ventricular assist device (pVAD)
                                                        • Intraaortic balloon pump (IABP)
                                                        • Total artificial hearts (TAH)
                                                      • Definitions

                                                        • Mechanical pump device used to augment cardiac output for failing ventricle
                                                          • LVAD goal
                                                            • Diverting oxygenated blood from left heart into aorta, bypassing left ventricular function
                                                          • RVAD goal
                                                            • Diverting blood from right ventricle to pulmonary artery, bypassing right ventricular function
                                                        • FDA approval of 1st LVAD as bridge to transplant was in 1994
                                                          • Heartmate II, III and HVAD devices are only commercially FDA-approved adult ventricular assist device (VAD) options in North America
                                                          • SynCardia TAH is only FDA-approved device in its class 
                                                        • Impella goal
                                                          • Transfer oxygenated blood via catheter tip in left ventricle to outlet in ascending aorta by axial flow

                                                      IMAGING ANATOMY

                                                      • General Anatomic Considerations

                                                        PATHOLOGY-BASED IMAGING ISSUES

                                                        • Key Concepts

                                                          CLINICAL IMPLICATIONS

                                                          • Clinical Importance

                                                            • Indications

                                                              • Contraindications

                                                                • Best Procedure Approach

                                                                  • Imaging Findings

                                                                    • Imaging Protocols

                                                                      • Imaging Pitfalls

                                                                        Equipment

                                                                        • Types

                                                                          • Components

                                                                            • Devices

                                                                              Post Procedure

                                                                              • Expected Outcome

                                                                                • Complications

                                                                                  Selected References

                                                                                  1. Dandel M et al: Temporary assist device support for the right ventricle: pre-implant and post-implant challenges. Heart Fail Rev. 23(2):157-71, 2018
                                                                                  2. Han JJ et al: Left ventricular assist devices. Circulation. 138(24):2841-51, 2018
                                                                                  3. Hanke JS et al: One-year outcomes with the HeartMate 3 left ventricular assist device. J Thorac Cardiovasc Surg. 156(2):662-9, 2018
                                                                                  4. Saeed D: Right ventricular failure and biventricular support strategies. Cardiol Clin. 36(4):599-607, 2018
                                                                                  5. Brixey AG et al: Innovative cardiac devices on chest imaging: an update. J Thorac Imaging. 32(6):343-57, 2017
                                                                                  6. DeVore AD et al: Medical management of patients with a left ventricular assist device for the non-left ventricular assist device specialist. JACC Heart Fail. 5(9):621-31, 2017
                                                                                  7. Mohamed I et al: Building a bridge to save a failing ventricle: radiologic evaluation of short- and long-term cardiac assist devices. Radiographics. 35(2):327-56, 2015
                                                                                  8. Mellnick VM et al: Imaging of left ventricular device complications. J Thorac Imaging. 28(2):W35-41, 2013
                                                                                  9. Mishkin JD et al: Utilization of cardiac computed tomography angiography for the diagnosis of left ventricular assist device thrombosis. Circ Heart Fail. 5(2):e27-9, 2012
                                                                                  10. Bolen MA et al: Left ventricular assist device malposition interrogated by 4-D cine computed tomography. J Cardiovasc Comput Tomogr. 5(3):186-8, 2011
                                                                                  11. Kar B et al: The percutaneous ventricular assist device in severe refractory cardiogenic shock. J Am Coll Cardiol. 57(6):688-96, 2011
                                                                                  12. Carr CM et al: CT of left ventricular assist devices. Radiographics. 30(2):429-44, 2010
                                                                                  13. Estep JD et al: The role of echocardiography and other imaging modalities in patients with left ventricular assist devices. JACC Cardiovasc Imaging. 3(10):1049-64, 2010