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(Circulation. 2002;106:I-189.)
© 2002 American Heart Association, Inc.

Thoracic Transplantation and Mechanical Support for Congestive Heart Failure

Treatment of Thrombus Formation Associated With the MicroMed DeBakey VAD Using Recombinant Tissue Plasminogen Activator

Markus Rothenburger, MD; Markus J. Wilhelm, MD; Dieter Hammel, MD; Christoph Schmidt, MD; Tonny D. T. Tjan, MD; Dirk Böcker, MD; Hans H. Scheld, MD; Christof Schmid, MD

From the Departments of Thoracic and Cardiovascular Surgery (M.R., M.J.W., D.H., T.D.T.T., H.H.S., C. Schmid), Anesthesiology and Operative Intensive Care Medicine (C. Schmidt), and epartment of Cardiology and Angiology (D.B.), University-Hospital Muenster, Germany.

Correspondence to Markus Rothenburger, MD, Department of Thoracic and Cardiovascular Surgery, University Hospital, Albert-Schweitzer Str. 33, 48129 Muenster, Germany. E-mail markus.rothenburger{at}thgms.uni-muenster.de

Abstract

Background The latest generation of left ventricular assist devices consists of nonpulsatile impeller pumps. In these small pumps, thrombus formation inside the device does not lead to thromboembolic end-organ dysfunction but may dramatically impair pump flow. We report on our experience with thrombus-related pump dysfunctions of the MicroMed DeBakey left ventricular assist device and its treatment.

Methods Eight of 22 patients with a MicroMed DeBakey VAD presented with a critically reduced pump flow. In 7 cases, an increased power demand indicative of progressive thrombus formation associated with the device was evident, whereas 1 case presented with thrombus formation within the inflow conduit associated with a very low power demand. Brief spontaneously resolving pump stops had been noted in 6 patients. All 8 patients were treated with 100 mg of recombinant tissue plasminogen activator (rt-PA), administered via an IV line.

Results Rt-PA lysis led to an increase of pump flow along with a reduction of power demand within a short time in all patients. No severe bleeding complications occurred. However, 4 patients experienced transient epistaxis. All patients could be discharged from intensive care immediately after discontinuation of thrombolytic therapy.

Conclusion Rt-PA lysis is a very effective tool for thrombus-related pump dysfunction in patients with impeller pumps, which renders emergency surgical exchange unnecessary in most cases.

Key Words: MicroMed DeBakey LVAD • thrombus formation • thrombolytic therapy • recombinant tissue plasminogen activator (rt-PA)