P1675Evolution of lactate dehydrogenase levels in patients with HeartMate II, HeartWare and HeartMate 3 left ventricular assist devices during first-year follow-up

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y C Yalcin ◽  
R Muslem ◽  
G Papageorgiou ◽  
R J Tedford ◽  
A A Constantinescu ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
First Year ◽  
Heartmate Ii ◽  
Ventricular Assist ◽  
Pump Thrombosis ◽  
Left Ventricular Assist ◽  
Over Time

Abstract Background Lactate dehydrogenase (LDH) is considered as a biomarker of thrombotic events in patients receiving a left ventricular assist device (LVAD). Purpose This study aimed to investigate the evolution of LDH levels over time between patients supported with a HeartMate II (HMII), HeartMate 3 (HM3) or HeartWare (HVAD) LVAD during their first-year post implantation. Methods We analyzed in this multi-center retrospective study, all patients with HMII, HM3 and HVAD LVAD implanted between December 2006 and April 2017. Patients were classified into three groups based on their device type. Loess splines over time were used to depict the repeated measurements of LDH. Results In total, 134 patients received an LVAD (77% male, mean age 55 [46–61]), of whom 64 (48%) were HMII, 22 (16%) HM3 and 48 (36%) were HVAD. Loess splines over time indicate that there could be a considerable difference between evolution of LDH (Figure). During the first-year follow-up, 3 (5%) patients had a confirmed and 10 (16%) patients had a suspected pump thrombosis in the HMII group. For the HVAD, there were 6 (13%) patients with confirmed thrombosis and 1 (2%) case of suspected thrombosis, whereas none of the patients in the HM3 group experienced a suspected or confirmed pump thrombosis (p=0.01). The 1-year overall survival rate for HM II, HM3 and HVAD was 84%, 86% and 72% respectively (p=0.311). The overall stroke-free rate at one year was: 89%, 77% and 91% for HMII, HVAD and HM3 respectively (p=0.15). Means of observed LDH values over time Conclusion During the first-year post LVAD implantation, there appear to be different evolutions of LDH levels over time in HMII device patients compared to HVAD or HM3 device patients. Given differences in baseline hemolysis levels between devices, currently used LDH thresholds for detection of impending pump thrombosis may be less sensitive and thus thresholds may be device specific.

HeartMate II Left Ventricular Assist Device Pump Exchange: A Single-Institution Experience

2016 ◽  
Vol 65 (05) ◽  
pp. 410-414 ◽  
Author(s):  
Asad Shaikh ◽  
Susan Joseph ◽  
Brian Lima ◽  
Shelley Hall ◽  
Rajasekhar Malyala ◽  
...  
Keyword(s):  
Median Sternotomy ◽  
High Volume ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Heartmate Ii ◽  
Ventricular Assist ◽  
Pump Thrombosis ◽  
Left Ventricular Assist ◽  
Driveline Infection

Background Left ventricular assist devices (LVADs) have revolutionized the treatment of patients with end-stage heart failure. These devices are replaced when pump complications arise if heart transplant is not possible. We present our experience with HeartMate II (HMII (Thoratec, Plesanton, California, United States)) LVAD pump exchange. Materials and Methods We retrospectively reviewed all cases that required pump exchange due to LVAD complication from November 2011 until June 2016 at a single high-volume institution. The indications, demographics, and outcome were extracted and analyzed. Results Of 250 total patients with implanted HMII LVADs, 16 (6%) required pump exchange during the study period. The initial indications for LVAD placement in these patients were bridge to transplantation (n = 6 [37.5%]) or destination therapy (n = 10 [62.5%]). Fifteen patients (93.8%) required pump exchange due to pump thrombosis and 1 (6.2%) due to refractory driveline infection. Nine patients (56.2%) underwent repeat median sternotomy while a left subcostal approach was used in the remaining seven patients. Fifteen patients (93.7%) survived until hospital discharge. During the follow-up period (median, 155 days), 11 patients remained alive and 4 of these underwent successful cardiac transplantation. Conclusion HMII LVAD pump exchange can be safely performed for driveline infection or pump thrombosis when heart transplantation is not an option.

Abstract 19810: A Significant Decrease in Early Confirmed Left Ventricular Assist Device Pump Thrombosis: Recent Observations from a Large Multi-Institutional Experience

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
John M Stulak ◽  
John A Schirger ◽  
Lyle D Joyce ◽  
Keith D Aaronson ◽  
Francis D Pagani ◽  
...  
Keyword(s):  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Similar Proportion ◽  
Assist Device ◽  
Heartmate Ii ◽  
Ventricular Assist ◽  
Pump Thrombosis ◽  
Left Ventricular Assist

Introduction: Recent reports have documented an abrupt increase in 3-month confirmed HeartMate II left ventricular assist device (LVAD) thrombosis beginning in 2011 without a plateau observed to date. Because very little data exist from multi-institutional efforts, we report our experience. Methods: From January 2004 to December 2013, 516 pt underwent HeartMate II LVAD implant at three institutions (University of Michigan (n=254), Mayo Clinic Rochester (n=205), and Vanderbilt Heart and Vascular Institute (n=57)). Median age at implant was 60 yr (range, 18-82) and 428 (83%) were male. Confirmed pump thrombosis at 3 months was defined as thrombus found in the blood-contacting surfaces of the pump at the time of urgent transplant, device exchange or autopsy. Pt without at least 3 months of follow-up were excluded. Results: Confirmed pump thrombosis occurred in 9 pt within 3 months post implant. The incidence was greatest in the year 2012 (5.3%). Following this peak, the incidence of 3-month confirmed pump thrombosis decreased significantly to 2.9% (Figure). Significant differences in preoperative characteristics between patients with pump thrombosis and without thrombosis included female sex (36% vs. 16%, p=0.01), bridge to transplant (77% vs. 54%, p=0.03), atrial fibrillation (55% vs. 32%, p=0.04), and preop platelet count (231,000 vs. 172,000, p<0.001). Follow-up was available in all for a total of 857 patient years of support. At a median follow-up of 1.2 years (max., 9.8 years), a similar proportion of patients were alive (73% vs. 74%, p=0.9). Conclusions: We report a recent decrease in early, confirmed HeartMate II LVAD thrombosis to historically observed levels, which is disparate to recent reports. While we identified several differences in clinical characteristics between patient groups, the issue of pump thrombosis is complex and multifactorial. Most importantly, our findings demonstrate the need for more granular analyses from collaborative efforts.

scholarly journals Normal Lactate Dehydrogenase Does Not Exclude Pump Thrombosis in Left Ventricular Assist Devices

2016 ◽  
Author(s):  
Julie Shelton ◽  
Bennet George ◽  
Amanda Hart ◽  
Maya Guglin
Keyword(s):  
Lactate Dehydrogenase ◽  
Left Ventricular ◽  
Normal Serum ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Pump Thrombosis ◽  
Left Ventricular Assist ◽  
Elevated Lactate ◽  
Objective Marker

Left ventricular assist device (LVAD) pump thrombosis is a well-known complication of LVAD placement. Elevated lactate dehydrogenase (LDH) has classically been the first objective marker of pump thrombosis. In this case, we present a patient found to have normal serum LDH values but was ultimately found to have significant pump thrombosis.

Pump Thrombosis following HeartMate II Left Ventricular Assist Device Implantation in a Patient with Aspirin and Plavix Resistance

2016 ◽  
Vol 19 (6) ◽  
pp. 284 ◽  
Author(s):  
Ali Ghodsizad ◽  
A. Badiye ◽  
M. Zeriouh ◽  
W. Pae ◽  
M.M. Koerner ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Assist Device ◽  
Heartmate Ii ◽  
Ventricular Assist ◽  
Power Pulse ◽  
Device Implantation ◽  
Pump Thrombosis ◽  
Left Ventricular Assist ◽  
Life Threatening

Despite advances in pump technology, thromboembolic events and pump thrombosis are potentially life-threatening complications in patients with continuous flow ventricular assist devices. Here we describe a patient with pump thrombosis following LVAD HeartMate II implantation presenting with Aspirin and Plavix resistance and signs of acute hemolysis as manifested by high LDH, changing pump power, pulse index and reduced pump flows.

Thrombus Formation Patterns in HeartMate II Continuous-Flow Left Ventricular Assist Devices

ASAIO Journal ◽  
2014 ◽  
Vol 60 (4) ◽  
pp. 369-371 ◽  
Author(s):  
Nicholas G. Kounis ◽  
George D. Soufras ◽  
Periklis Davlouros ◽  
Grigorios Tsigkas ◽  
George Hahalis
Keyword(s):  
Continuous Flow ◽  
Thrombus Formation ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Heartmate Ii ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist
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