Diyar Saeed1, Bujar Maxhera2, Alexander Albert2, Ralf Westenfeld3, Till Hoffmann4, Artur Lichtenberg2. 1. Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany diyar.saeed@med.uni-duesseldorf.de. 2. Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany. 3. Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany. 4. Institute for Hemostaseology, Haemotherapy and Transfusion Medicine, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
Abstract
PURPOSE: Left ventricular assist device (LVAD) pump thrombosis is one of the devastating complications following mechanical circulatory support implantation. Surgical pump exchange is a known high-risk surgery with a high perioperative mortality rate. We aim to summarize our experience with several other alternative approaches in patients with suspected HeartWare HVAD (HeartWare, Framingham, MA, USA) pump thrombosis. METHODS: The outcome of HeartWare HVAD implantations performed at single institution from January 2010 to September 2015 was studied. Inclusion criteria were patients with suspected HeartWare HVAD pump thrombosis. Patients' preoperative characteristics and outcome following various interventions were reviewed. RESULTS: A total of 94 HeartWare HVAD pumps were implanted in 91 patients. The inclusion criteria were met by 13 patients (14%) with a mean age of 55 ± 14 years old and a median total pump support duration of 467 days (11-937 days). A conservative approach using systemic thrombolysis (recombinant tissue plasminogen activator) + heparin was used in the majority of the patients (15 events = 65%). Heart transplantation was performed in 4 patients and device explantation in 2 patients. Other approaches were used in the rest of patients. Considering thrombolysis-related complications, 1 patient required resternotomy for bleeding after thrombolysis, which was necessary a few days after LVAD implant surgery and 2 patients developed minor intracranial bleeding after thrombolysis. One-year survival after the latest intervention was 69%. CONCLUSIONS: This report showed the feasibility of several alternative conservative approaches combining medications, minimally invasive and interventional methods for patients with HeartWare pump thrombosis. The outcome may be better than immediate surgical pump exchange.
PURPOSE: Left ventricular assist device (LVAD) pump thrombosis is one of the devastating complications following mechanical circulatory support implantation. Surgical pump exchange is a known high-risk surgery with a high perioperative mortality rate. We aim to summarize our experience with several other alternative approaches in patients with suspected HeartWare HVAD (HeartWare, Framingham, MA, USA) pump thrombosis. METHODS: The outcome of HeartWare HVAD implantations performed at single institution from January 2010 to September 2015 was studied. Inclusion criteria were patients with suspected HeartWare HVAD pump thrombosis. Patients' preoperative characteristics and outcome following various interventions were reviewed. RESULTS: A total of 94 HeartWare HVAD pumps were implanted in 91 patients. The inclusion criteria were met by 13 patients (14%) with a mean age of 55 ± 14 years old and a median total pump support duration of 467 days (11-937 days). A conservative approach using systemic thrombolysis (recombinant tissue plasminogen activator) + heparin was used in the majority of the patients (15 events = 65%). Heart transplantation was performed in 4 patients and device explantation in 2 patients. Other approaches were used in the rest of patients. Considering thrombolysis-related complications, 1 patient required resternotomy for bleeding after thrombolysis, which was necessary a few days after LVAD implant surgery and 2 patients developed minor intracranial bleeding after thrombolysis. One-year survival after the latest intervention was 69%. CONCLUSIONS: This report showed the feasibility of several alternative conservative approaches combining medications, minimally invasive and interventional methods for patients with HeartWare pump thrombosis. The outcome may be better than immediate surgical pump exchange.
Authors: Behzad Soleimani; Edward R Stephenson; Lauren C Price; Aly El-Banayosy; Walter E Pae Journal: Ann Thorac Surg Date: 2015-07-30 Impact factor: 4.330
Authors: James K Kirklin; David C Naftel; Francis D Pagani; Robert L Kormos; Lynne W Stevenson; Elizabeth D Blume; Marissa A Miller; J T Baldwin; J Timothy Baldwin; James B Young Journal: J Heart Lung Transplant Date: 2014-04-21 Impact factor: 10.247
Authors: Fenton H McCarthy; Dale Kobrin; J Eduardo Rame; Peter W Groeneveld; Katherine M McDermott; Pavan Atluri; Michael A Acker; Nimesh D Desai Journal: Ann Thorac Surg Date: 2015-07-21 Impact factor: 4.330
Authors: Samer S Najjar; Mark S Slaughter; Francis D Pagani; Randall C Starling; Edwin C McGee; Peter Eckman; Antone J Tatooles; Nader Moazami; Robert L Kormos; David R Hathaway; Kevin B Najarian; Geetha Bhat; Keith D Aaronson; Steven W Boyce Journal: J Heart Lung Transplant Date: 2013-12-12 Impact factor: 10.247
Authors: Giuseppe M Raffa; Giuseppe D'Ancona; Sergio Sciacca; Astrid Pietrosi; Cesar M Hernandez Baravoglia; Marco Turrisi; Giuseppe Romano; Alessandro Armaro; Vincenzo Stringi; Francesco Clemenza; Michele Pilato Journal: Artif Organs Date: 2015-03-04 Impact factor: 3.094
Authors: Randall C Starling; Nader Moazami; Scott C Silvestry; Gregory Ewald; Joseph G Rogers; Carmelo A Milano; J Eduardo Rame; Michael A Acker; Eugene H Blackstone; John Ehrlinger; Lucy Thuita; Maria M Mountis; Edward G Soltesz; Bruce W Lytle; Nicholas G Smedira Journal: N Engl J Med Date: 2013-11-27 Impact factor: 91.245
Authors: Henrik Fox; Takayuki Gyoten; Sebastian V Rojas; Volker Lauenroth; Sabina Günther; René Schramm; Jan F Gummert; Michiel Morshuis Journal: Interact Cardiovasc Thorac Surg Date: 2022-06-15
Authors: R Hamdan; S Fakih; M Mohammad; F Charif; H Abdallah; S Safa; F Al Ali; M Issa; B Damen; A El Zein; M Younes; A Rabah; M Saab Journal: J Cardiothorac Surg Date: 2020-07-28 Impact factor: 1.637