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A Stepwise Approach to Left Ventricular Assist Device Pump Thrombosis
Sinan Sabit Kocabeyoglu1, Umit Kervan1, Dogan Emre Sert1
1Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
Heart, Lung & Circulation
|August 27, 2020
Summary
Pump thrombosis (PT) is a serious complication of left ventricular assist device (LVAD) therapy. Low-dose thrombolytic therapy shows promise for treating PT, with high rates of freedom from recurrent events.
Area of Science:
- Cardiology
- Medical Devices
- Thrombosis
Background:
- Pump thrombosis (PT) is a significant complication associated with left ventricular assist device (LVAD) therapy.
- Optimal treatment strategies for PT remain undefined, necessitating further research.
Purpose of the Study:
- To present a treatment strategy for patients experiencing pump thrombosis (PT) after LVAD implantation.
- To investigate risk factors associated with PT development.
Main Methods:
- Retrospective analysis of hospital records for patients undergoing LVAD implantation (May 2013 - October 2018).
- PT diagnosis based on impaired flow/power parameters and hemolysis.
- Risk factor analysis by comparing patients with and without PT.
Main Results:
- PT occurred in 20 of 81 LVAD patients, presenting with elevated lactate dehydrogenase and pump alarms.
- Initial treatment with unfractionated heparin was administered; some patients required urgent LVAD exchange or died.
- Thirteen patients received tissue plasminogen activator (tPA) infusion, with 8 discharged free of thrombosis and 3 bridged to transplant.
- Freedom from second PT was 91% at 6 months and 68.2% at 1 year.
- Larger left ventricle size and pump type were identified as PT risk factors.
Conclusions:
- Low-dose thrombolytic therapy, such as tPA infusion, is a viable treatment option for PT.
- Further investigation into PT management strategies is warranted.
