Bleeding and thrombosis associated with ventricular assist device therapy

Shah, Palak; Tantry, Udaya S.; Bliden, Kevin P.; Gurbel, Paul A.

doi:10.1016/j.healun.2017.05.008

Cited by 92 publications

(61 citation statements)

References 66 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…23,30 Additionally, considering renal function, 8 lowering PAP by better unloading LV and providing better cardiac output will improve renal function. Congestion can be a sign of development of aortic valve regurgitation and pump dysfunction (kinking outflow graft or bent relief), resulting in higher PAP.…”

Section: Other Research Areas Of Interestmentioning

confidence: 99%

See 1 more Smart Citation

Design and rationale of haemodynamic guidance with CardioMEMS in patients with a left ventricular assist device: the HEMO‐VAD pilot study

et al. 2019

View full text Add to dashboard Cite

AimsWe aim to study the feasibility and clinical value of pulmonary artery pressure monitoring with the CardioMEMS™ device in order to optimize and guide treatment in patients with a HeartMate 3 left ventricular assist device (LVAD).Methods and resultsIn this single‐centre, prospective pilot study, we will include 10 consecutive patients with New York Heart Association Class IIIb or IV with Interagency Registry for Mechanically Assisted Circulatory Support Classes 2–5 scheduled for implantation of a HeartMate 3 LVAD. Prior to LVAD implantation, patients will receive a CardioMEMS sensor, for daily pulmonary pressure readings. The haemodynamic information provided by the CardioMEMS will be used to improve haemodynamic status prior to LVAD surgery and optimize the timing of LVAD implantation. Post‐LVAD implantation, the haemodynamic changes will be assessed for additive value in detecting potential complications in an earlier stage (bleeding and tamponade). During the outpatient clinic phase, we will assess whether the haemodynamic feedback can optimize pump settings, detect potential complications, and further tailor the clinical management of these patients.ConclusionsThe HEMO‐VAD study is the first prospective pilot study to explore the safety and feasibility of using CardioMEMS for optimization of LVAD therapy with additional (remote) haemodynamic information.

show abstract

Section: Other Research Areas Of Interestmentioning

confidence: 99%

“…This will lead to signs and symptoms of HF and pulmonary congestion. 23,30 Additionally, considering renal function, 8 lowering PAP by better unloading LV and providing better cardiac output will improve renal function. However, when kidney failure occurs and patients' urine production declines, PAP might rise.…”

Section: Other Research Areas Of Interestmentioning

confidence: 99%

Design and rationale of haemodynamic guidance with CardioMEMS in patients with a left ventricular assist device: the HEMO‐VAD pilot study

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In addition, interruption of anticoagulation due to the bleeding risk associated with an elective procedure may also lead to an elevated risk of thromboembolism, even if heparin bridging is implemented. A recent study recommended an extended personalized approach that incorporates the extent of the patient's underlying risk for thrombosis and bleeding [20].…”

Section: Discussionmentioning

confidence: 99%

“…In LVAD patients, severe right heart failure is a thrombotic risk factor [20] and may be induced by hypovolemia. Therefore, preoperative volume management with anticoagulation therapy is important to avoid thrombus formation.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of a patient with a continuous-flow left ventricular assist device for video-assisted thoracoscopic surgery: a case report

Iwata

Yokokawa

et al. 2020

BMC Anesthesiol

View full text Add to dashboard Cite

Background: As patients with left ventricular assist device (LVAD) have long expected survival, the incidence of noncardiac surgery in this patient population is increasing. Here, we present the anesthetic management of a patient with a continuous-flow LVAD who underwent video-assisted thoracic surgery (VATS). Case presentation: A 37-year-old man with LVAD was scheduled to undergo VATS because of repeated spontaneous pneumothorax. Generally, patients with these devices have marginal right heart function; therefore, it is important to avoid factors that worsen pulmonary vascular resistance (PVR). However, VATS requires one-lung ventilation (OLV) and it tends to cause increase in PVR, leading to right heart failure. In the present case, when the patient was set in a lateral decubitus position and progressive hypoxia was observed during OLV, transesophageal echocardiography demonstrated a dilated right ventricle and a temporally flattened interventricular septum, and the central venous pressure increased to approximately 20 mmHg. Because we anticipated deterioration of right heart function, dobutamine and milrinone were administered and/or respirator settings were changed to decrease PVR for maintaining LVAD performance. Finally, resection of a bulla was completed, and the patient was discharged in stable condition on postoperative day 37. Conclusions: The anesthetic management of a patient with LVAD during VATS is challenging because the possible hemodynamic changes induced by hypoxia associated with OLV affect LVAD performance and right heart function. In our experience, VATS that requires OLV will be well tolerated in a patient with LVAD with preserved right heart function, and a multidisciplinary approach to maintain right heart function will be needed.

show abstract

“…With the increasing clinical use of blood pumps to treat and cure severe heart failure patients, adverse events have occurred, such as gastrointestinal bleeding, stroke, right heart failure, and pump thrombosis, impacting the benefits of blood pumps . Pump thrombosis occurs despite anticoagulation and results in pump failure or serious thromboembolism .…”

Section: Introductionmentioning

confidence: 99%

Platelet deposition estimation: A novel method for emulating the pump thrombosis potential of blood pumps

et al. 2020

View full text Add to dashboard Cite

Pump thrombosis potential exists in most blood pumps and limits their clinical use. To improve the pump thrombosis performance of blood pumps, a method for emulating the platelet deposition on the flow passage component surfaces inside blood pumps was presented and tested. The method emulates the blood platelet deposition, employing laser‐induced fluorescence tracing technology. The blood pump was rotated in a mock circulation loop with deionized water filled with fluorescent particles. The component surfaces were then explored via laser. The fluorescent particles were induced by laser and imaged in a charge‐coupled device (CCD) camera to show the distribution of fluorescent particles gathering on the blood pump component surfaces. The activated platelet deposition was emulated by fluorescent particle gathering. The experiment showed obvious particle gathering on the interface surfaces and cross‐sectional surface (perpendicular to the flow). This platelet deposition estimation (PDE) method can be easily incorporated in the in vitro testing phase to analyze and decrease a pump’s thrombosis potential before animal experimentation, thereby reducing the cost of blood pump development. This methodology of emulating blood platelet deposition indicates its potential for improving flow passage component structure and reducing device thrombosis of blood pumps.

show abstract

Bleeding and thrombosis associated with ventricular assist device therapy

Cited by 92 publications

References 66 publications

Design and rationale of haemodynamic guidance with CardioMEMS in patients with a left ventricular assist device: the HEMO‐VAD pilot study

Design and rationale of haemodynamic guidance with CardioMEMS in patients with a left ventricular assist device: the HEMO‐VAD pilot study

Anesthetic management of a patient with a continuous-flow left ventricular assist device for video-assisted thoracoscopic surgery: a case report

Platelet deposition estimation: A novel method for emulating the pump thrombosis potential of blood pumps

Contact Info

Product

Resources

About