Diagnosis and Treatment Algorithm for Blood Flow Obstructions in Patients With Left Ventricular Assist Device

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• 作者：Anna Mara Scandroglio ; MD^a ; ^{mara.scandroglio@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Friedrich Kaufmann ; DIPL ING^b ; Marina Pieri ; MD^a ; Alexandra Kretzschmar ; MD^b ; Marcus Mü ; ller ; MD^b ; Panagiotis Pergantis ; MD^c ; Stephan Dreysse ; MD^c ; Volkmar Falk ; MD ; PhD^b ; ^d ; ^e ; Thomas Krabatsch ; MD ; PhD^b ; ^d ; Evgenij V. Potapov ; MD ; PhD^b ; ^d
• 关键词：algorithm ; complication ; left ventricular assist device ; mechanical circulatory support ; thrombosis
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：14 June 2016
• 年：2016
• 卷：67
• 期：23
• 页码：2758-2768
• 全文大小：2108 K

文摘

Thrombosis is an uncommon, but severe complication of left ventricular assist devices (LVADs).

Objectives

This study analyzed experience with obstruction of blood flow through the LVAD with the purpose of developing optimal diagnosis and treatment of LVAD-related thrombosis.

Methods

Between October 2009 and July 2015, a total of 652 LVAD were implanted in 557 patients. Blood flow abnormalities in patients with LVAD (n = 524) were identified and classified as “high-power” and “low-flow” events.

Results

Three types of late blood flow obstructions were identified: 1) pre-pump via thrombus obstructing the inflow cannula (26 events; 0.037 events per patient-year); 2) intra-pump (70 events; 0.1 events per patient-year); and 3) post-pump via thrombosis of the outflow graft or stenosis of the anastomosis to the aorta (4 events; 0.006 events per patient-year). Pre-pump obstruction was treated by washout maneuver in 9 cases (success rate, 100%), thrombolysis in 9 patients (success rate, 56%), and pump exchange in 9 cases (success rate, 100%); 1 patient died without treatment and 2 were weaned from LVAD. Intra-pump obstruction was treated by thrombolysis (n = 9; success rate, 33%), pump exchange (n = 53; success rate, 94%), and removal due to myocardial recovery (n = 3; success rate, 100%); 7 patients died without treatment and parameters spontaneously normalized in 2 cases. Post-pump obstruction was treated in 2 patients by stenting (success rate, 100%), and was left untreated in 2 cases.

Conclusions

We identified 3 types of LVAD-related blood flow obstruction, and developed an algorithm for optimal diagnosis and treatment.