Geometry-Related Technical Complications After LVAD Implantation: Impact on Device Dysfunction and Clinical Outcomes.

BACKGROUND: Geometry of LVAD implantation is a determinant of pump performance and hemocompatibility. Despite technically successful operations, avoidable geometric errors may produce characteristic imaging patterns and clinically relevant device dysfunction. OBJECTIVES: To determine the frequency, diagnostic pathway, and clinical impact of preventable geometry-related failure modes after HeartMate 3 implantation in a single-center referral cohort, specifically inflow cannula malposition, outflow graft kinking/excessive length, and aortic anastomotic stenosis. METHODS: Retrospective, single-center analysis of 21 consecutive HeartMate 3 recipients implanted between 2016 and 2025 at external centers and subsequently evaluated in our department. All patients underwent CT/CTA when device dysfunction was suspected. Failure modes were predefined and adjudicated using standardized imaging criteria. CT/CTA was the primary modality used to confirm geometric failure modes following triggers such as low-flow alarms, hemolysis, and abnormal chest radiography. RESULTS: Among 21 HeartMate 3 recipients, inflow cannula malposition was identified in 7 patients, outflow graft kinking/excessive length in 12, and aortic anastomotic stenosis in 2. CONCLUSIONS: In this single-center referral cohort, geometric failure modes were identified in 15 of 21 patients (71.4%) after HeartMate 3 implantation and showed reproducible CT/CTA signatures. A standardized imaging-driven diagnostic pathway may improve recognition of correctable geometric problems in patients referred for suspected device dysfunction; given the referral-based design, these frequencies should not be interpreted as the true incidence in an unselected HeartMate 3 population.