Failed repeated thrombolysis requiring left ventricular assist device pump exchange.

Area of Science:

• Cardiology
• Medical Devices
• Hepatology

Background:

• A 51-year-old male with untreated hepatitis C, cirrhosis, and dilated cardiomyopathy utilized a HeartMate II Left Ventricular Assist Device (LVAD).
• The patient presented with signs of right heart failure and cardiogenic shock, including elevated INR, hemolysis, and renal failure.

Observation:

• Acute LVAD thrombosis was suspected as the primary cause of the patient's decompensation.
• Initial attempts at thrombolysis, including direct injection into the inflow cannula and intravenous alteplase, were ineffective in restoring adequate pump function.

Findings:

• The LVAD pump was surgically exchanged due to persistent failure despite thrombolytic therapy.
• Post-operative inspection revealed a thrombus lodged within the LVAD impeller, obstructing its function.

Implications:

• LVAD thrombosis can be refractory to standard thrombolytic treatments, necessitating alternative management strategies.
• Prompt surgical intervention, such as pump exchange, may be crucial for resolving severe LVAD thrombosis.
• This case underscores the complex interplay between liver disease, anticoagulation, and mechanical circulatory support device thrombosis.