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Low thromboembolic risk without anticoagulation using advanced-design left ventricular assist devices
J P Slater1, E A Rose, H R Levin
1Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, USA.
The Annals of Thoracic Surgery
|November 1, 1996
Summary
The HeartMate left ventricular assist device (LVAD) shows a low rate of thromboembolic events, even with minimal anticoagulation. This suggests its potential for long-term heart failure treatment.
Area of Science:
- Cardiovascular Medicine
- Biomedical Engineering
Background:
- Systemic anticoagulation is a major limitation for cardiac assist devices due to high thromboembolic event rates.
- The HeartMate 1000 IP left ventricular assist device (LVAD) features a design potentially reducing thromboembolic risk and the need for anticoagulation.
Purpose of the Study:
- To evaluate the thromboembolic complication rate in patients supported with the HeartMate LVAD.
- To assess the efficacy of minimal anticoagulation strategies in patients with advanced heart failure.
Main Methods:
- Prospective monitoring of 223 patients with nonreversible heart failure receiving HeartMate LVAD support as a bridge to transplantation.
- Recording of anticoagulation regimens and occurrence of thromboembolic events, including subclinical events detected via transcranial Doppler in select patients.
Main Results:
- A total of 531.2 patient-months of LVAD support was analyzed.
- Only 6 patients (2.7%) experienced thromboembolic events, resulting in a rate of 0.011 events per patient-month.
- Warfarin was administered postoperatively to 10% of patients for 8.2% of the total support time.
Conclusions:
- The HeartMate LVAD demonstrates an acceptably low thromboembolic complication rate.
- Minimal anticoagulation strategies are feasible with this LVAD, supporting its consideration for long-term heart failure management.