Medical Therapy As Compared To Surgical Device Exchange for Left Ventricular Assist Device Thrombosis: A Systematic Review and Meta-Analysis

Abstract

Pump thrombosis is a major adverse event in patients supported on left ventricular assist devices (LVAD). The aim of this systematic review and meta-analysis was to determine the outcomes of various treatment approaches for pump thrombosis, including surgical or medical therapy. Electronic search was performed to identify all studies in the English literature addressing surgical and medical management of pump thrombosis in the modern LVAD era. All identified articles were systematically assessed for inclusion and exclusion criteria. In the meta-analysis, because of significant overlap of the data, reports based on trials, registries, and individual cohort studies were analyzed separately. Forty-three studies were included in the analysis (2 trials, 4 registry reports, and 37 individual cohort studies). 2,281/28,728 (10.6%) patients developed pump thrombosis of which 44.4% and 55.1% were supported on the HeartWare and HeartMate II, respectively. To avoid overlap in studies and seek more granular data, pooled individual cohort studies were found to be representative of the entire population, and further in-depth analysis of this category was performed. Of the 610/5,545 (11.8%) patients with pump thrombosis in these individual cohort studies, 225 patients had surgical pump exchange, and 186 were treated medically. Surgical therapy resulted in higher success compared with medical therapy (81.3% vs. 45.4%; p < 0.001), lower 30 day mortality rate (16.7% vs. 34.5%; p = 0.013) and recurrence rate (11.8% vs. 38.3%; p < 0.001). Meta-regression of all studies demonstrates a possible temporal increase of the thrombosis rate (p = 0.040). Surgical pump exchange is superior to medical therapy with a higher success rate of pump thrombosis resolution, lower mortality rate, and lower recurrence rate. Randomized controlled prospective studies are needed to compare these clinical approaches and their resultant outcomes to guide decision-making for the management of Continuous-flow LVAD thrombosis.

Clinical implications of LDH isoenzymes in hemolysis and continuous‐flow left ventricular assist device‐induced thrombosis

“…Nonmechanical issues can be further subdivided into prepump factors (eg, atrial fibrillation, right ventricular failure), postpump factors (eg, reduced flow within the aortic root), and systemic factors (eg, inflammation, infection, withholding of anticoagulation therapy in the setting of bleeding, and preexisting/de novo hypercoagulable states) . Options and outcomes for surgical and medical management following diagnosis of pump thrombosis has been previously reviewed by our group …”

“…31 Options and outcomes for surgical and medical management following diagnosis of pump thrombosis has been previously reviewed by our group. 28,32…”

“…Blood pumps or continuous‐flow left ventricular assist devices (CF‐LVADs), either in the form of implantable or extracorporeal devices, have emerged as a promising therapeutic alternative for end‐stage heart failure . With growing utilization of CF‐LVADs for end‐stage heart failure, adverse events remain common leading to significant patient morbidity and mortality . One such major complication is pump thrombosis.…”

“…3,[8][9][10] With growing utilization of CF-LVADs for end-stage heart failure, adverse events remain common leading to significant patient morbidity and mortality. [11][12][13][14][15][16][17][18][19][20] One such major complication is pump thrombosis. The incidence of pump thrombosis has been estimated to be between 1.4% and 13.9%, and is largely dependent on the device.…”

Update on Stem Cell‐Based Therapy and Mechanical Cardiac Support: A North American Perspective

“…Given the shortage of donor hearts, mechanical circulatory support has been increasingly utilized for long‐term support with survival approaching that of orthotopic heart transplantation . Mechanical circulatory support, however, comes with the inherent risk of adverse events such as infection , stroke , bleeding , thrombosis , or device malfunction . As such, a method to achieve ventricular recovery is desirable.…”