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Cardiac Imaging

E2606. Cardiac Assist Devices: What the Radiologist Needs to Know

Singh K,  Hartman M. Allegheny General Hospital, Pittsburgh, PA

Address correspondence to K. Singh (ksingh@wpahs.org)

Background Information: Aging population and prolongation of lives of cardiac patients by modern treatments has increased prevalence of heart failure. There are currently an estimated 5.8 million people with heart failure in the United States. Despite significant advances in pharmacologic and nonpharmacologic therapies, heart failure often progresses to refractory to treatment. Cardiac transplantation remains the definitive treatment; however, limited availability of donor organs had led to development of alternative therapies. One such therapy is cardiac assist devices that take over the function of a failing ventricle. In addition to use as a bridge to transplant or destination therapy, cardiac assist devices are also increasingly being used in acute heart failure settings. This exhibit, will enable the audience to recognize commonly used cardiac assist devices and understand their imaging evaluation.

Educational Goals/Teaching Points: We review different types of available support devices, and their indications, contraindications, and mechanisms of action. Next, we discuss imaging evaluation of these devices as it pertains to positioning, device components, and their complications through a variety of radiography, CT, angiography, and echocardiography. Recommendations regarding management and appropriate follow-up for complications are also reviewed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Short-term temporary devices Impella, intraaortic balloon pump, extracorporeal membrane oxygenation, TandemHeart, and long-term devices Javrik 2000, HeartWare, HeartMate II, HeartMate 3, and total artificial heart will be discussed. Examples of complications include malposition, device failure, pump thrombosis, thromboembolism, thrombocytopenia, hemolysis, gastrointestinal bleeding, mediastinitis, endocarditis, device-related infections, right ventricular dysfunction, pericardial effusion, limb ischemia, and explanation-related complications.

Conclusion: With increasing use of cardiac assist devices in patients with heart failure, imaging will play a crucial role in evaluation of these devices. Radiologists involved in chest imaging need to be familiar with radiographic appearance of these devices and their associated complications.