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

Urban, Marian; Um, J.; Moulton, Michael; Stoller, Douglas; Zolty, Ronald; Lowes, Brian D.; Macdonald, C.; McCain, Natalia; Siddique, Aleem

doi:10.1177/0391398819876293

Cited by 6 publications

(6 citation statements)

References 37 publications

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“…It is the first time that we adopt the IST to treat the thrombosis on LVAD. Here, we review clinical studies about thrombolytic technologies on implantable and interventional devices in recent years [ 2 , 3 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] and compare the IST with other currently used thrombolytic technologies, including medical therapy, pump exchange, sonothrombolysis, washout maneuver, and mechanical thrombectomy. Safety and efficiency are focused on in the evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…However, it has the incidence of hemorrhagic stroke, [ 2 , 3 , 15 , 16 , 17 , 18 , 19 , 20 ] and need a relative long treatment time, usually >3 h. [ 2 ] Pump exchange is an urgent treatment, but it has a high surgical risk because most of the patients can't suffer another reopen heart surgery. [ 21 , 22 , 23 , 24 , 25 , 26 ] Washout maneuver is used to remove the thrombus at the inlet of LVAD. Although it shows a good success ratio, the risk is still high because the thrombus washed from LVAD will enter other organs.…”

Section: Discussionmentioning

confidence: 99%

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Interventional Microbubble Enhanced Sonothrombolysis on Left Ventricular Assist Devices

et al. 2022

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The left ventricular assist device (LVAD) is often used in the treatment of heart failure. However, 4% to 9% implanted LVAD will have thrombosis problem in one year, which is fatal to the patient's life. In this work, an interventional sonothrombolysis (IST) method is developed to realize the thrombolysis on LVAD. A pair of ultrasound transducer rings is installed on the shell of LVAD, and drug-loaded microbubbles are injected into the LVAD through the interventional method. The microbubbles are adhere on the thrombus with the coated thrombus-targeted drugs, and the thrombolytic drugs carried by the bubbles are brought into the thrombus by the cavitation of bubbles under the ultrasound. In a proof-of-concept experiment in a live sheep model, the thrombus on LVAD is dissolved in 30 min, without damages on LVADs and organs. This IST exhibits to be more efficient and safer compared with other thrombolysis methods on LVAD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Interventional Microbubble Enhanced Sonothrombolysis on Left Ventricular Assist Devices

et al. 2022

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“…Urban et al exchanged four devices with a sternotomy approach and 15 with a subcostal approach, but they found no significant difference between the method of approach and relevant outcomes. 12 Takeda et al exchanged all 9 devices using the subcostal approach. Three of these patients developed a delayed infection in the old pump pocket site that required surgical intervention and antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

Infection following CF-LVAD exchange for non-infectious indications: A systematic review and meta-analysis

et al. 2022

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Introduction: Patients on continuous flow left ventricular assist devices (CF-LVADs) often require CF-LVAD exchange. The purpose of this study was to investigate the incidence of infection following CF-LVAD exchange performed for non-infectious indications. Methods: An electronic literature search was performed to identify all studies of patients undergoing CF-LVAD exchange for pump thrombosis or device malfunction. Of 2,698 articles identified, 6 studies with 81 total patients met the inclusion criteria. Cohort-level data were pooled for meta-analysis. Results: Mean patient age was 60 years (95% CI: 41–78), and 74% were male (95% CI: 61–84). Pump thrombosis was the most common indication for exchange in 70% of patients (95% CI: 47–86). Other indications were driveline fracture and electrical malfunction in 21% (95% CI: 5–56) and 12% (95% CI: 4–33) of patients, respectively. Prior to exchange, 95% of patients were on HeartMate II (HM2) LVADs (95% CI: 86–98) and average duration of support for these patients was 27.1 months (95% CI: 9.3–44.8). The majority were placed on a HM2 following exchange (88% (95% CI: 45–98)) versus HM3 (12% (95% CI: 2–55)). Follow-up was an average of 16.4 months (95% CI: 6.8–26.0). Following exchange, 16 of 81 patients developed infection, with pooled mean incidence of 24% (95% CI: 14–38). 30-day mortality was 14% (95% CI: 7–26). Survival at follow-up was 65% (95% CI: 52–76). Conclusions: Infection following CF-LVAD exchange can occur at rates higher than those observed with primary implantation; therefore, effective strategies need to implemented early and consistently to help lower infections rates and help improve outcomes following exchange.

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“…However, these pumps provide improved life of the patient with mobility and help in myocardial recovery compared to previous generation pumps. Furthermore, the other limitations are their driveline infection, use of extracorporeal power source, hemolysis, and demand for anticoagulation therapy as they are prone to thromboembolic events (126,127).…”

Section: Geometry Representationmentioning

confidence: 99%

Analysis of rotary ventricular assist devices using CFD technique—A Review

Shukla

Mishra

Tewari

2022

Proceedings of the Institution of Mechanical Engineers, Part E:

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With the increasing focus on reducing deaths because of heart ailments, considerable emphasis has been directed toward the development of ventricular assist devices (VADs) that work on the principle of mechanical pumps for supporting an infirm heart. The VADs are used primarily to assist the left ventricle, but their use has been extended for supporting the right ventricle as well as for supporting both ventricles simultaneously. In this connection, computational fluid dynamics (CFD) has evolved as an efficient technique for the design, development, evaluation, and optimization of VADs, enabling the prediction of operational characteristics of VADs as well as detailed global and local flow characteristics for an extensive set of working environments even before the manufacture and use of the actual device. CFD techniques yield valuable insight into the VADs’ effectiveness that enhances its operational behavior and decreases the risk associated with the use of the device, and at the same time decreases the manufacturing lead time and costs associated with the device. CFD has been quite beneficially used for the performance evaluation of VADs, but it still needs further development as hemolysis and thrombosis models cannot be easily integrated with the flow simulations. This review article presents abrief introduction to rotary VADs with a primary focus on the current status of CFD analysis of axial VADs, which provide the most suitable methods for computational design and optimization of VADs. It also identifies critical knowledge gaps and outlines the hematological models and the difficulties encountered in integrating them into CFD. Finally, future work based on the current scenario is also included.

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

Cited by 6 publications

References 37 publications

Interventional Microbubble Enhanced Sonothrombolysis on Left Ventricular Assist Devices

Interventional Microbubble Enhanced Sonothrombolysis on Left Ventricular Assist Devices

Infection following CF-LVAD exchange for non-infectious indications: A systematic review and meta-analysis

Analysis of rotary ventricular assist devices using CFD technique—A Review

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