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

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.

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Aortic Valve Opening at Hospital Discharge After HeartMate II Left Ventricular Assist Device Implantation Is Associated With Improved Renal Function at 3 Months

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2011.06.124 ◽

2011 ◽

Vol 17 (8) ◽

pp. S37

Author(s):

David R. Fermin ◽

Soon J. Park ◽

Yan Topilsky ◽

John C. Burnett ◽

Tal Hasin ◽

...

Keyword(s):

Renal Function ◽

Aortic Valve ◽

Left Ventricular Assist Device ◽

Left Ventricular ◽

Assist Device ◽

Heartmate Ii ◽

Ventricular Assist ◽

Device Implantation ◽

Left Ventricular Assist ◽

Valve Opening

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Results of HeartMate II left ventricular assist device implantation on renal function in patients requiring post-implant renal replacement therapy

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2010.08.019 ◽

2011 ◽

Vol 30 (2) ◽

pp. 182-187 ◽

Cited By ~ 115

Author(s):

Zumrut T. Demirozu ◽

Whitson B. Etheridge ◽

Rajko Radovancevic ◽

O.H. Frazier

Keyword(s):

Renal Function ◽

Renal Replacement Therapy ◽

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Assist Device ◽

Heartmate Ii ◽

Ventricular Assist ◽

Device Implantation ◽

Left Ventricular Assist

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Recurrent pump thrombosis is common after axial continuous-flow left ventricular assist device exchange

The International Journal of Artificial Organs ◽

10.1177/0391398819876293 ◽

2019 ◽

Vol 43 (2) ◽

pp. 109-118 ◽

Cited By ~ 1

Author(s):

Marian Urban ◽

John Um ◽

Michael Moulton ◽

Douglas Stoller ◽

Ronald Zolty ◽

...

Keyword(s):

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Assist Device ◽

Heartmate Ii ◽

Ventricular Assist ◽

Pump Thrombosis ◽

Left Ventricular Assist ◽

Device Associated Infection ◽

Device Exchange

In selected patients with left ventricular assist device–associated infection or malfunction, pump exchange may become necessary after conservative treatment options fail and heart transplantation is not readily available. We examined the survival and complication rate in patients (⩾19 years of age) who underwent HeartMate II to HeartMate II exchange at our institution from 1 January 2010 to 28 February 2018. Clinical outcomes were analyzed and compared for patients who underwent exchange for pump thrombosis (14 patients), breach of driveline integrity (5 patients), and device-associated infection (2 patients). There were no differences in 30-day mortality (p = 0.58), need for temporary renal replacement therapy (p = 0.58), right ventricular mechanical support (p = 0.11), and postoperative stroke (p = 0.80) among groups. Survival at 1 year was 90% ± 7% for the whole cohort and 85% ± 10% for those who underwent exchange for pump thrombosis. In patients exchanged for device thrombosis, freedom from re-thrombosis and survival free from pump re-thrombosis at 1 year were 49% ± 16% and 42% ± 15%, respectively. No association of demographic and clinical variables with the risk of recurrent pump thrombosis after the first exchange was identified. Survival after left ventricular assist device exchange compares well with published results after primary left ventricular assist device implantation. However, recurrence of thrombosis was common among patients who required a left ventricular assist device exchange due to pump thrombosis. In this sub-group, consideration should be given to alternative strategies to improve the outcomes.

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Optimization with levosimendan improves outcomes after left ventricular assist device implantation

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz159 ◽

2019 ◽

Vol 57 (1) ◽

pp. 176-182

Author(s):

Sinan Sabit Kocabeyoglu ◽

Umit Kervan ◽

Dogan Emre Sert ◽

Mehmet Karahan ◽

Emre Aygun ◽

...

Keyword(s):

Right Ventricular ◽

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Assist Device ◽

Ventricular Assist ◽

Device Implantation ◽

Left Ventricular Assist ◽

Right Ventricular Assist Device

Abstract OBJECTIVES The aim of this study was to examine the haemodynamic effects of preoperative levosimendan infusion in patients who underwent left ventricular assist device implantation and evaluate the prognoses. METHODS Between May 2013 and October 2018, 85 adult patients who underwent left ventricular assist device implantation were included; 44 and 41 patients suffered from dilated cardiomyopathy and ischaemic cardiomyopathy, respectively. Patients were divided into 2 groups: group A (58 patients) included those who received levosimendan infusion in addition to other inotropes and group B (27 patients) included those who received inotropic agents other than levosimendan. Levosimendan infusion was started at a dose of 0.1 µg⋅kg−1⋅min−1 for a maximum of 48 h without a bolus. The primary outcome was early right ventricular failure (RVF). The secondary outcomes were in-hospital mortality, need for right ventricular assist device, late RVF and recovery of end-organ functions. The safety end points of levosimendan included hypotension, atrial fibrillation, ventricular tachycardia or fibrillation and resuscitated cardiac arrest. RESULTS Patient characteristics were similar in both groups. No significant differences between groups were observed in the rates of early mortality, RVF, need for right ventricular assist device, cardiopulmonary bypass time and intensive care unit stay. Survival rates at 30 days, 1 year and 3 years and freedom from late RVF were similar between the groups. Administration of levosimendan was safe, generally well-tolerated and not interrupted because of side effects. CONCLUSIONS Levosimendan therapy was well-tolerated in patients who received permanent left ventricular assist devices. Combined preoperative therapy with inotropes and levosimendan significantly improves end-organ functions.

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Blood damage in Left Ventricular Assist Devices: Pump thrombosis or system thrombosis?

The International Journal of Artificial Organs ◽

10.1177/0391398818806162 ◽

2018 ◽

Vol 42 (3) ◽

pp. 113-124 ◽

Cited By ~ 6

Author(s):

Matteo Selmi ◽

Wei-Che Chiu ◽

Venkat Keshav Chivukula ◽

Giulio Melisurgo ◽

Jennifer Ann Beckman ◽

...

Keyword(s):

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Assist Device ◽

Ventricular Assist ◽

Assist Devices ◽

Pump Thrombosis ◽

Left Ventricular Assist

Introduction: Despite significant technical advancements in the design and manufacture of Left Ventricular Assist Devices, post-implant thrombotic and thromboembolic complications continue to affect long-term outcomes. Previous efforts, aimed at optimizing pump design as a means of reducing supraphysiologic shear stresses generated within the pump and associated prothrombotic shear-mediated platelet injury, have only partially altered the device hemocompatibility. Methods: We examined hemodynamic mechanisms that synergize with hypershear within the pump to contribute to the thrombogenic potential of the overall Left Ventricular Assist Device system. Results: Numerical simulations of blood flow in differing regions of the Left Ventricular Assist Device system, that is the diseased native left ventricle, the pump inflow cannula, the impeller, the outflow graft and the anastomosed downstream aorta, reveal that prothrombotic hemodynamic conditions might occur at these specific sites. Furthermore, we show that beyond hypershear, additional hemodynamic abnormalities exist within the pump, which may elicit platelet activation, such as recirculation zones and stagnant platelet trajectories. We also provide evidences that particular Left Ventricular Assist Device implantation configurations and specific post-implant patient management strategies, such as those allowing aortic valve opening, are more hemodynamically favorable and reduce the thrombotic risk. Conclusion: We extend the perspective of pump thrombosis secondary to the supraphysiologic shear stress environment of the pump to one of Left Ventricular Assist Device system thrombosis, raising the importance of comprehensive characterization of the different prothrombotic risk factors of the total system as the target to achieve enhanced hemocompatibility and improved clinical outcomes.

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