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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Thromboembolic complications during weaning from right ventricular assist device support
Corinna Velik-Salchner1, Christoph Hoermann, Daniel Hoefer
1Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria. corinna.velik@i-med.ac.a
Anesthesia and Analgesia
|July 18, 2009
Summary
Prolonged weaning from Levitronix CentriMag right ventricular assist device support can cause dangerous blood clots. Reducing device flow requires caution, and extra heparin may be needed to prevent thrombosis.
Area of Science:
- Cardiovascular Medicine
- Biomedical Engineering
Background:
- Right ventricular assist devices (RVADs) like the Levitronix CentriMag are crucial for managing heart failure.
- Weaning patients from RVAD support requires careful hemodynamic and echocardiographic monitoring.
Observation:
- Two patients on Levitronix CentriMag RVAD support developed life-threatening thromboembolic complications.
- Reduced RVAD flow (<2 L/min) for extended periods (36-72h) was implemented to assess right ventricular recovery.
- Thrombus formation occurred despite therapeutic anticoagulation with heparin.
Findings:
- Prolonged periods of reduced RVAD flow, even with therapeutic anticoagulation, pose a significant risk of thrombosis.
- The standard heparinization protocol was insufficient to prevent clot formation during reduced flow states.
Implications:
- Clinicians must exercise extreme caution when reducing flow during RVAD weaning.
- Shorter periods of reduced flow and consideration of additional heparin boluses are recommended to mitigate thromboembolic risk.
- This highlights the need for optimized anticoagulation strategies during RVAD weaning.
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