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

Anna Mara Scandroglio, Friedrich Kaufmann, Marina Pieri, Alexandra Kretzschmar, Marcus Müller, Panagiotis Pergantis, Stephan Dreysse, Volkmar Falk, Thomas Krabatsch, Evgenij V. Potapov

Research output: Contribution to journalArticlepeer-review

Abstract

Background 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.
Original languageEnglish
Pages (from-to)2758 - 2768
Number of pages11
JournalJournal of the American College of Cardiology
Volume67
Issue number23
DOIs
Publication statusPublished - 2016

Keywords

  • algorithm
  • complication
  • left ventricular assist device
  • mechanical circulatory support
  • thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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