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In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
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Pump Position Impacts HeartMate II Left Ventricular Assist Device Thrombosis
Ahmet Kilic1, John Ransom2, Simon Maltais3
1From the Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|June 29, 2018
Summary
Optimizing HeartMate II pump position during left ventricular assist device implantation can significantly reduce the risk of pump thrombosis (PT), hemolysis, and other adverse events. Proper device placement is crucial for improved patient outcomes and event-free survival.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Medical Device Technology
Background:
- Left ventricular assist devices (LVADs) are critical for end-stage heart failure management.
- Pump thrombosis (PT) remains a significant complication in HeartMate II LVAD recipients.
- Standardized surgical and medical practices may influence PT rates.
Purpose of the Study:
- To evaluate the rate of pump thrombosis (PT) in the PREVENtion of HeartMate II pump Thrombosis through clinical management (PREVENT) study.
- To identify if specific HeartMate II pump positions are associated with adverse clinical outcomes.
- To determine the impact of pump position on event-free survival.
Main Methods:
- Prospective, multicenter study (PREVENT) evaluating HeartMate II LVAD implantation.
- Chest X-rays used to assess pump pocket depth and inflow cannula (IC) angles.
- Categorization of 'extreme pump position' based on IC angle and pocket depth distributions.
- Multivariable analysis to identify independent risk factors for PT.
Main Results:
- Patients with an extreme pump position had a significantly higher risk of confirmed/suspected PT, hemolysis, and elevated lactate dehydrogenase.
- Extreme pump position was an independent risk factor for PT (HR=3.6, p=0.006) in multivariable analysis.
- Pump position significantly impacted event-free survival and adverse events at 6 months.
Conclusions:
- HeartMate II pump position at implantation is a critical factor influencing patient outcomes.
- Avoiding extreme pump positions may reduce the incidence of pump thrombosis and related complications.
- Optimizing device placement is essential for improving survival free of adverse events in LVAD patients.
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