Durable Continuous-Flow Mechanical Circulatory Support: State of the Art

Loforte, Antonio; Botta, Luca; Boschi, Silvia Regina Matos da Silva; Gliozzi, Gregorio; Cavalli, Giulio; Mariani, Carlo; Suàrez, Sofia Martìn; Pacini, Davide

doi:10.3390/hearts2010010

Cited by 2 publications

(1 citation statement)

References 42 publications

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“…Both pumps were externally powered, connected to an external energy source via the driveline tunneled in abdominal tissues and exiting on the skin surface. Pump ow was regulated by altering the rotation speed in the external controller 14 . Pump speed adjustment was performed by an experienced transplant physician based on echocardiography and patient' clinical condition 15 .…”

Section: Materials/patients and Methodsmentioning

confidence: 99%

Fibrin clot permeability (Ks) in patients on left ventricular assist device

Kuczaj,

Skrzypek,

Hudzik

et al. 2024

Preprint

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Background Patients on left ventricular assist devices (LVAD) are prone to excessive hemostasis disturbances due to permanent contact of artificial pump surfaces with blood components. Aims We aimed to investigate if fibrin clot permeability is altered in patients on long-term continuous flow LVAD therapy and if the clot permeability is associated with clinical characteristics and adverse events. Methods We investigated 85 end-stage heart failure patients (90.6% men, age 48.6–63.8 years) scheduled for continuous flow long-term LVAD support according to current clinical indications. The patients were assessed periodically: prior to LVAD implantation (T1), 3–6 months (T2) after LVAD implantation, 6–12 months after (T3) and then every 6 months. We tested the first three blood samples (T1-T3) and the last available blood sample (T4), but no longer than 5 years after LVAD implantation. We assessed hemostasis parameters changes during the study period. Results MACCE occurred in 36.5% patients, bleeding events in 25.9%, NACE in 62.4%; 31.7% patients died, and 17.6% underwent transplantation. We observed a decrease in fibrin clot permeability (Ks) between T1, T2, T3 and T4 time periods; P < 0.01 for each comparison. Fibrin clot permeability was negatively correlated with fibrinogen concentration: r = 0.51, P < 0.001, factor VIII activity r=-0.42, P < 0.001. Discrepancies in Ks were observed between patients with MACCE, bleeding, and NACE, and patients without adverse events. Ks showed a constant trend towards normalization (P < 0.01) only in patients without adverse events. Conclusions Adverse events such as MACCE, NACE, and bleeding may be associated with inappropriate fibrin clot structure.

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Section: Materials/patients and Methodsmentioning

confidence: 99%

Fibrin clot permeability (Ks) in patients on left ventricular assist device

Kuczaj,

Skrzypek,

Hudzik

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

Clot lysis time in patients with end-stage heart failure on mechanical circulatory support: long-term observation

Kuczaj,

Hudzik,

Skrzypek

et al. 2024

Postępy Higieny I Medycyny Doświadczalnej

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Introduction Despite being on antithrombotic therapy patients with left ventricular assist devices (LVAD) are susceptible to thromboembolic events. Therefore, we investigated whether LVAD has an influence on the fibrinolytic capacity of the plasma. The aim of the study was to assess the clot lysis time (CLT) in the course of time in LVAD patients and the connection between CLT and adverse events in this group of patients. Materials and Methods We investigated end-stage HF patients scheduled for LVAD (n=85, men 90.6%; age 48.6–63.8 years) at four consecutive time points: prior to LVAD implantation, 3–4 months, 6–12 months, and then every 6 months; the CLT was determined in the first three blood samples and the last, at the end of observation (no longer than 5 years after implantation). Enrolled for further analyses were patients who completed four observations, n=23. MACCE were defined as all-cause mortality, ischemic stroke and TIA, peripheral/pulmonary embolism, and pump thrombosis. NACE included MACCE and bleeding complications. Results Patients with HF showed longer CLT median [IQR], when compared to reference values: 111.25 [97–300] vs. 84.8 [75.0–98.5] min, P<0.001. MACCE occurred in 36.5% pts, bleeding events in 25.9% pts and NACE in 62.4% pts. Deaths occurred in 31.8% pts. Patients without NACE during the whole observation period showed shortened CLT in the last long-term observation P=0.025. Conclusions This study is the first to show that patients scheduled for LVAD are characterized by prothrombotic fibrin clot properties. The CLT value in long-term observation is lower in patients without NACE.

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Durable Continuous-Flow Mechanical Circulatory Support: State of the Art

Cited by 2 publications

References 42 publications

Fibrin clot permeability (Ks) in patients on left ventricular assist device

Fibrin clot permeability (Ks) in patients on left ventricular assist device

Clot lysis time in patients with end-stage heart failure on mechanical circulatory support: long-term observation

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