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Systemic or Endoventricular Thrombolysis to Treat HeartWare Left Ventricle Assist Device Thrombosis: A Clinical

Giuseppe M Raffa1, Giuseppe D'Ancona1, Sergio Sciacca1

  • 1Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy.

Artificial Organs
|March 5, 2015
PubMed

Insights

Endoventricular thrombolytic procedures (ETP) for continuous-flow left ventricle assist device (CF-LVAD) thrombosis frequently cause vascular access complications. These complications increase patient risk and healthcare costs, suggesting a need for less invasive treatments.

Area of Science:

  • Cardiovascular Surgery
  • Medical Devices
  • Interventional Cardiology

Background:

  • Continuous-flow left ventricle assist devices (CF-LVADs) are crucial for advanced heart failure treatment.
  • Pump thrombosis is a significant complication associated with CF-LVADs.
  • Endoventricular thrombolytic procedure (ETP) is a treatment option for CF-LVAD thrombosis.

Purpose of the Study:

  • To investigate the incidence and types of complications following Endoventricular thrombolytic procedures (ETP) in patients with CF-LVAD thrombosis.
  • To assess the safety and risks associated with ETP in this patient population.

Main Methods:

  • Retrospective analysis of patients who underwent CF-LVAD implantation and subsequent ETP.
  • Review of procedural data, including access routes and complications.
  • Analysis of complication rates, such as radial artery occlusion and hematomas.

Main Results:

  • Four out of 20 (20%) CF-LVAD patients developed pump thrombosis requiring ETP.
  • Nine ETPs were performed, with a high complication rate of 55.5% for vascular access.
  • Specific complications included radial artery occlusion (5 ETPs), groin hematomas (2 ETPs), and femoral artery false aneurysm (1 ETP).

Conclusions:

  • Endoventricular thrombolytic procedures (ETP) carry a substantial risk of vascular access complications in CF-LVAD patients.
  • These complications can exacerbate the existing clinical complexity and economic burden.
  • Less invasive treatment strategies for CF-LVAD thrombosis should be considered.

Keywords:
Continuous-flow pumpThrombolysisVascular access-site complications

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