Resolution of hemolysis from pump thrombus during left ventricular assist device exchange

Area of Science:

• Cardiology
• Medical Devices
• Hematology

Background:

• Left ventricular assist devices (LVADs) like the HeartMate II are used for end-stage heart failure.
• Ischemic cardiomyopathy is a common indication for LVAD implantation.
• Pump thrombosis is a known complication of LVADs, leading to hemolysis.

Observation:

• A 50-year-old male with a HeartMate II developed cola-colored urine and hemolysis 3 months post-implantation.
• Initial imaging failed to detect a left ventricular thrombus.
• Anticoagulation therapy was ineffective in resolving the hemolysis.

Findings:

• Intraoperative findings during pump exchange revealed a firm thrombus within the HeartMate II pump.
• The patient's urine color changed from cola-colored to yellow immediately after pump replacement.
• This clinical presentation and resolution confirmed pump thrombosis as the cause of hemolysis.

Implications:

• This case highlights the importance of considering pump thrombosis in LVAD recipients presenting with hemolysis, even with negative initial imaging.
• Prompt diagnosis and surgical intervention (pump exchange) can effectively treat LVAD thrombosis and associated hemolysis.
• Monitoring urine color can serve as a simple, albeit indirect, indicator of hemolysis in LVAD patients.