Echocardiographic assessment of a novel blood-guiding accessory for left ventricular assist devices in swine

OBJECTIVES Left ventricular assist devices are part of the foundations of mechanical circulatory support. As such devices evolve in technology, so does their implantation techniques, becoming less invasive. We developed a novel blood-guiding accessory for less invasive implantation, redirecting the blood intracardially into the ascending aorta through a transaortic outflow. METHODS Ten healthy female swine (German Landrace, 104.4 ± 13.0 kg) underwent epicardial echocardiography before and after left ventricular assist device implantation. Cardiac geometry, aortic valve function and outflow positioning, were assessed before and after implantation. RESULTS Epicardial echocardiography revealed sufficient biventricular unloading after device implantation. The end-diastolic and end-systolic left ventricular diameters decreased by 16% and 20%, respectively. Retrograde unloading was displayed by smaller diameters in left and right atria at 22% and 25%, respectively. At baseline, one animal presented mild aortic regurgitation, unchanged under mechanical support, whereas one developed mild de novo insufficiency. The outflow graft was either well centered within the aortic valve (n = 3) or between two cusps. CONCLUSIONS A left ventricular assist device with the accessory allowed sufficient ventricular unloading, preserving biventricular function. Although the outflow graft was well centered within the aortic valve in only 30% of the cases, no relevant aortic regurgitation was found in the acute setting. Chronic testing in larger samples is required to analyze results in long term.