Journal Article

Conservative approaches for HeartWare ventricular assist device pump thrombosis may improve the outcome compared with immediate surgical approaches

Diyar Saeed, Bujar Maxhera, Alexander Albert, Ralf Westenfeld, Till Hoffmann and Artur Lichtenberg

in Interactive CardioVascular and Thoracic Surgery

Volume 23, issue 1, pages 90-95
Published in print July 2016 | ISSN: 1569-9293
Published online March 2016 | e-ISSN: 1569-9285 | DOI: https://dx.doi.org/10.1093/icvts/ivw063
Conservative approaches for HeartWare ventricular assist device pump thrombosis may improve the outcome compared with immediate surgical approaches

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  • History of Medicine
  • Cardiothoracic Surgery
  • Cardiovascular Medicine
  • Anatomy

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PURPOSE

Left ventricular assist device (LVAD) pump thrombosis is one of the devastating complications following mechanical circulatory support implantation. Surgical pump exchange is a known high-risk surgery with a high perioperative mortality rate. We aim to summarize our experience with several other alternative approaches in patients with suspected HeartWare HVAD (HeartWare, Framingham, MA, USA) pump thrombosis.

METHODS

The outcome of HeartWare HVAD implantations performed at single institution from January 2010 to September 2015 was studied. Inclusion criteria were patients with suspected HeartWare HVAD pump thrombosis. Patients’ preoperative characteristics and outcome following various interventions were reviewed.

RESULTS

A total of 94 HeartWare HVAD pumps were implanted in 91 patients. The inclusion criteria were met by 13 patients (14%) with a mean age of 55 ± 14 years old and a median total pump support duration of 467 days (11–937 days). A conservative approach using systemic thrombolysis (recombinant tissue plasminogen activator) + heparin was used in the majority of the patients (15 events = 65%). Heart transplantation was performed in 4 patients and device explantation in 2 patients. Other approaches were used in the rest of patients. Considering thrombolysis-related complications, 1 patient required resternotomy for bleeding after thrombolysis, which was necessary a few days after LVAD implant surgery and 2 patients developed minor intracranial bleeding after thrombolysis. One-year survival after the latest intervention was 69%.

CONCLUSIONS

This report showed the feasibility of several alternative conservative approaches combining medications, minimally invasive and interventional methods for patients with HeartWare pump thrombosis. The outcome may be better than immediate surgical pump exchange.

Keywords: Cardiomyopathy; Heart-assist device; Surgery; Heart failure; Pump thrombosis; Complications

Journal Article.  5291 words.  Illustrated.

Subjects: History of Medicine ; Cardiothoracic Surgery ; Cardiovascular Medicine ; Anatomy

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