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Acute Pump Thrombosis in the Early Postoperative Period After HeartMate 3 Implantation

Jeroen J H Bunge1,2, Corstiaan A den Uil1,2, Alina C Constantinescu1

  • 1From the Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|January 26, 2019
PubMed

Insights

Acute thrombosis in HeartMate 3 continuous-flow left ventricular assist devices is rare. This case highlights early pump and outflow graft thrombosis, likely caused by low-flow episodes and inadequate anticoagulation, requiring device replacement.

Area of Science:

  • Cardiovascular Surgery
  • Biomedical Engineering
  • Medical Device Technology

Background:

  • Continuous-flow left ventricular assist devices (CF-LVADs) are crucial for advanced heart failure management.
  • The HeartMate 3 (HM3) is a centrifugal-flow CF-LVAD known for its hemocompatibility and low thrombosis rates.
  • Thrombosis remains a significant concern in LVAD therapy, impacting device longevity and patient outcomes.

Observation:

  • This report details an unusual case of early-onset thrombosis affecting both the HeartMate 3 pump and its outflow graft.
  • The patient experienced symptoms necessitating emergent surgical intervention, including pump explantation and outflow graft revision.
  • No prior reports document acute thrombosis of the HeartMate 3 pump itself, excluding thrombus ingestion.

Findings:

  • The primary identified causes for this early thrombosis were recurrent episodes of low device flow and suboptimal anticoagulation levels.
  • These factors likely contributed to a prothrombotic environment within the device and associated vasculature.
  • The case underscores the importance of vigilant monitoring of device performance and anticoagulation in LVAD patients.

Implications:

  • This case expands the understanding of potential thrombotic complications associated with the HeartMate 3 LVAD.
  • It emphasizes the need for careful management of anticoagulation and device flow parameters to prevent early pump thrombosis.
  • Further research into HM3 thrombosis mechanisms and preventative strategies is warranted to optimize patient safety and device efficacy.

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