Abstract 19675: Management of Pump Thrombosis in Heartware Hvad Patients
Introduction: Implantable continuous-flow left ventricular assist device (LVAD) HeartWare HVAD has found broad acceptance, but a significant number of patients present with pump thrombosis (PT). We report our diagnostic and therapeutic strategy.
Methods: We retrospectively analyzed pump thrombosis in 540 patients supported with the HeartWare HVAD in 8/2009-5/2015. Our anticoagulation protocol consisted of bridging with heparin until sufficient oral anticoagulation. Patients with clear evidence of pre- or post-device thrombus (n=5 and n=3) were excluded.
Suspected PT was defined as marked increase of LVAD power consumption, significant increase of hemolysis (according to Intermacs definitions) and/or positive signals in acoustic analysis. Confirmed PT was defined as either demonstration of thrombotic material in the explanted LVAD or complete disappearance of hemolysis and normalization of device parameters after thrombolytic therapy.
Results: As median support in this group was 248 (range 0-2106) days the cohort represents 617 patient-years. Eighty-three episodes of PT were detected in 66 patients with 10 of these episodes successfully treated by thrombolysis (15%). PT occurred within 2-1521 days after primary implantation, median 349 days. Cumulative rate of all types of PT per patient-year (EPPY) was 0.13, with 0.11 for proven and 0.02 for suspected PT.
The decision to exchange the pump was triggered by marked hemolysis and/or high power consumption or failed thrombolysis, if initiated.
Fifty-five operative pump exchanges, including 5 after unsuccessful thrombolysis were necessary in 48 patients 5 patients experienced two and 1 patient three exchanges. Fifty pump exchanges were performed via lateral mini-thoracotomy and five through a median re-sternotomy.
Eight patients died before pump exchange. The hospital discharge rate was 62% after the first and 100% after the second and third pump exchange.
Conclusions: Minority of pump thrombosis after HeartWare implantation could be cured medically. As most thrombosed devices can be exchanged through a lateral mini-thoracotomy with low postoperative mortality, the pump exchange should not be delayed and then even repeated thrombotic events can be handled successfully.
Author Disclosures: T. Krabatsch: None. F. Kaufmann: None. C. Hörmandinger: None. M. Müller: None. A. Kretzschmar: None. P. Pergantis: None. V. Falk: None. E.V. Potapov: None.
- © 2015 by American Heart Association, Inc.