Left ventricular assist device exchange for the treatment of HeartMate II pump thrombosis

Abstract

Between February 2004 and December 2015, 87 exchanges of LVADs were performed at a single center. In 41 cases pump thrombosis was the reason for LVAD exchange. A total of 28 patient years (10,276 days) were analyzed. Average ICU stay was 15.8±20.4 days and average in-hospital stay 38.1±37.3 days after LVAD exchange. After thirty days the survival rate was 80.5%, 75.6% after 6 months and 70.7% one year after LVAD exchange. Out of the study cohort, three patients have successfully undergone heart transplantation. Twelve patients suffered a stroke postoperatively (29%). Twelve patients needed postoperative dialysis (29%). No technical complications of the VAD were recorded in the study group. Two patients underwent successful LVAD explantation due to myocardial recovery. One year after LVAD exchange, 14 patients underwent re-exchange due to pump thrombosis (34%). Eight patients suffered from a LVAD related infection out of which two patients were treated by pump exchange. A total of 12 patients died during the complete one year follow up of this study (29%). Four patients died in the second, two in the third and one in the fourth year after LVAD exchange. The remaining 17 patients are still ongoing on the device. It is generally feasible to treat pump thrombosis via LVAD exchange. Yet, the exchange procedure is not without risk and the risk of re-thrombosis (34%), stroke (29%), postoperative dialysis (29%) and perioperative complications remains high.

Shear-Mediated Platelet Activation is Accompanied by Unique Alterations of Platelet Lipid Profile

“…As a result of the rise in heart failure, the use of ventricular assist devices that promote blood flow will increase. While advancements in VAD design have reduced shear stress, VADs are still a significant source of hyper-shear forces [15], leading to shear-induced thrombosis [51]. As such, it is essential to understand the mechanical activation of platelets and how it may differ from other modes of activation.…”

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

“…Previously published single-center data estimate the overall risk of recurrent device thrombosis after device exchange for the same to be between 21% and 33%. 6,17 Hanke et al 7 analyzed a cohort of 16 patients supported with HeartMate II who underwent device exchange for pump thrombosis. Within the first year, two patients were transplanted, one was explanted for recovery, and four died.…”

HeartMate 3 pump exchange via sternal‐sparing bilateral minithoracotomies

“…Numerous studies have demonstrated that LVAD exchange is technically possible, 6,7 but not without perioperative risks 8 . The less invasive subcostal approach for HMII exchange has been shown to have numerous benefits compared with re‐entry median sternotomy, including decreased transfusion requirements, shorter hospital length of stay, and improved overall survival 1,2,9 .…”

“…Numerous studies have demonstrated that LVAD exchange is technically possible, 6,7 but not without perioperative risks. 8 The less invasive subcostal approach for HMII exchange has been shown to have numerous benefits compared with re-entry median sternotomy, including decreased transfusion requirements, shorter hospital length of stay, and improved overall survival. 1,2,9 A less invasive approach for HM3 exchange is considered more technically challenging given the newer device's intrapericardial location and lack of associated pump pocket, reducing the physical space the surgeon is afforded to operate.…”