Preoperative Left Ventricular Thrombus and Midterm Outcomes Following Left Ventricular Assist Device Support

Background: Preoperative left ventricular thrombus (LVT) may complicate left ventricular assist device (LVAD) implantation by increasing surgical complexity and potentially predisposing patients to thromboembolic events. However, the clinical significance of LVT in the era of LVAD support remains unclear. This study aimed to evaluate whether preoperative LVT influences early and mid-term outcomes after durable LVAD implantation. Methods: This retrospective, single-center cohort study included 81 adult patients who underwent LVAD implantation between January 2012 and December 2024. Twenty-one patients had documented preoperative LVT. Propensity score matching (1:1) was performed, resulting in 21 matched pairs. All patients with LVT underwent intraoperative thrombectomy. Postoperative outcomes included ischemic and hemorrhagic stroke, pump thrombosis, infectious complications, ventricular arrhythmias, duration of device support, and postoperative echocardiographic parameters. Results: After matching, baseline characteristics were generally comparable. Ischemic stroke incidence was identical (4.8% vs. 4.8%). Hemorrhagic stroke occurred in one LVT patient (4.8%) and in none of the controls. Pump thrombosis was numerically higher in LVT patients (9.5% vs. 4.8%) but not statistically significant. Rates of driveline infection (33.3% vs. 57.1%), bloodstream infection (19.0% vs. 28.6%), and ventricular arrhythmias (19.0% vs. 23.8%) were similar. Postoperative echocardiographic parameters and aortic valve opening patterns were comparable. The median LVAD support duration did not differ significantly (1003 vs. 821 days). Conclusions: Preoperative LVT was not associated with statistically significant differences in adverse outcomes following LVAD implantation when managed with surgical thrombectomy and standardized anticoagulation. However, given the small matched cohort and wide confidence intervals, clinically meaningful differences cannot be excluded. These findings require confirmation in larger prospective studies.