Continuous-flow ventricular assist device exchange is safe and effective in prolonging support time in patients with end-stage heart failure

Anand, Jatin; Singh, Steve K.; Hernandez, Ruben; Parnis, Steven M.; Civitello, Andrew B.; Cohn, William E.; Mallidi, Hari R.

doi:10.1016/j.jtcvs.2014.08.054

Cited by 23 publications

(15 citation statements)

References 34 publications

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“…1–7 The resulting rotational flow pattern is susceptible to the formation of vortices and other disturbances that may promote thrombosis. 8, 9 These conditions may be exacerbated by the flow-pulsatility contributed by the native heart.…”

Section: Introductionmentioning

confidence: 99%

“…Hence it is possible, in fact likely, that the flow patterns within the pump will be disturbed during portions of the cardiac cycle depending on the intensity of pulsatility. These factors have become increasingly relevant with the noted observance of a rising rate of LVAD pump thrombosis in the HeartMate II implantable LVAD (Thoratec, Pleasanton, CA) 10–12 requiring device-exchange 13–16 and/or resulting in adverse cerebrovascular events 10, 12, 15, 17 . A number of mechanisms have been described as triggers of this complication that relate to the principles of Virchow’s triad.…”

Section: Introductionmentioning

confidence: 99%

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High-speed visualization of disturbed pathlines in axial flow ventricular assist device under pulsatile conditions

Yang

Kormos

Antaki

2015

The Journal of Thoracic and Cardiovascular Surgery

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Objective: To investigate potentially pro-thrombotic flow patterns within an axial flow ventricular assist device under clinically relevant pulsatile hemodynamic conditions. Methods A transparent replica of the HeartMate-II was visualized using a high speed camera at both low and high frame rates (125 and 3000 fps). Three steady-state conditions were studied: nominal (4.5 lpm), low flow (3.0 lpm) and high flow (6.0 lpm). Time-varying conditions were introduced with external pulsatile pump which modulated the flow rate by approximately +/−50% of the mean, corresponding to a pulsatility index of 1.0. Results At nominal and high flow rates, the path lines within the upstream region were generally stable, well attached, and streamlined. As the flow rate was reduced below 3.8 lpm, a rapid transition to a chaotic velocity field occurred exhibiting a large toroidal vortex adjacent to the upstream bearing. The pathlines in the downstream stator section were consistently chaotic for all hemodynamic conditions investigated. It was common to observe tracer particles trapped within recirculation bubbles and drawn retrograde, causing repeated contact with the bearing surfaces. The addition of pulsatility caused the flow field to become periodically chaotic during the diastolic portion of the cardiac cycle depending on the instantaneous flow rate and acceleration. Conclusion The contribution of pulsatility by the native heart may induce a periodic disturbance to an otherwise stable flow field within an axial flow VAD, particularly during the diastolic and decelerating portion of the cardiac cycle. Potentially pro-thrombotic flow features were found to occur periodically in the region of the upstream bearing.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High-speed visualization of disturbed pathlines in axial flow ventricular assist device under pulsatile conditions

Yang

Kormos

Antaki

2015

The Journal of Thoracic and Cardiovascular Surgery

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“…If external splice repair is felt to not be a viable option, then a shared‐decision‐making discussion is held with the patient to discuss the risks and benefits of pump exchange compared with ungrounded cable. Multiple studies have demonstrated that device exchange can be done with relatively low rate of perioperative complications or mortality . Pump exchange has the benefit of definitively fixing the damage, but does carry the inherent risks associated with undergoing an operation and may be associated with an increased risk of postoperative infection or recurrent thrombosis .…”

Section: Discussionmentioning

confidence: 99%

Long‐term ungrounded cable support for short‐to‐shield syndrome

Ayers

Cheyne

Wood

et al. 2020

Clinical Case Reports

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Short‐to‐shield (STS) is a potential complication for left ventricular assist device (LVAD) patients supported by the HeartMate II (HMII) pump. This phenomenon occurs when a damaged internal wire within the driveline makes contact with the surrounding sheath, resulting in insufficient power delivery to the motor when connected to a grounded power base unit (PBU). An ungrounded cable can be used to negate these effects, but the long‐term safety of this treatment strategy is unknown. In this case series, we present our institutional experience treating 17 STS patients with an ungrounded cable. In total, we present 4922 patient‐days (13.4 patient‐years) of ungrounded cable support after primary STS treatment. There were no deaths or complications related to STS. These data suggest that the long‐term use of an ungrounded cable is a reasonable treatment option for patients who cannot or do not wish to undergo pump exchange or splice repair.

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“…Surgical management is the mainstay treatment for pump thrombosis and pump thrombosis accounts for up to 60% of pump exchanges (7,(12)(13)(14)(15). Surgical management is the mainstay treatment for pump thrombosis and pump thrombosis accounts for up to 60% of pump exchanges (7,(12)(13)(14)(15).…”

Section: Incidence and Etiology Of Thrombosismentioning

confidence: 99%

The Use of Eptifibatide Alone or in Combination With Heparin or Argatroban for Suspected Thrombosis in Patients With Left Ventricular Assist Devices

et al. 2017

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Pump thrombosis and hemolysis in patients with left ventricular assist devices (LVADs) are associated with significant morbidity and mortality. Intensification of anticoagulation has been suggested as potential therapy, with mixed results. The aim of this study is to assess the safety and efficacy of adding eptifibatide with or without an anticoagulation agent in managing patients with LVAD presenting with hemolysis and suspected pump thrombosis. This retrospective single center study included all patients who presented with their first episode of suspected pump thrombosis and were treated with eptifibatide with or without an anticoagulant between March 1, 2011 and July 30, 2015. A total of 27 patients (23 HeartMate II, 4 HeartWare) were identified. The average age was 55 years (range 19-75) and time from implant to event averaged 513 days (range 35-1760). The average lactate dehydrogenase on presentation was 1111 and 63% of patients had power elevations. The average international normalized ratio (INR) on admission was 2.4, with INR of ≥2 in 21/27 patients. All patients received eptifibatide: 10 received eptifibatide only, 9 received eptifibatide and argatroban, and 8 received eptifibatide and heparin. Warfarin was continued in 25/27 patients. Overall, 21 patients (77.8%) were successfully treated medically, 5 (18.5%) underwent pump exchange, and 1 (3.7%) died. There were no differences in outcomes or complications between the three treatment groups. Despite initial success, 12/21 patients developed repeat episodes of hemolysis at 1 year. The 1-year survival in the patients treated medically was 90% and surgically was 60%. Our experience indicates that medical therapy for hemolysis and suspected LVAD thrombosis with warfarin and eptifibatide alone or in combination with argatroban or heparin appears safe and may be effective, although the episodes of recurrent hemolysis after medical management remain high.

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Continuous-flow ventricular assist device exchange is safe and effective in prolonging support time in patients with end-stage heart failure

Cited by 23 publications

References 34 publications

High-speed visualization of disturbed pathlines in axial flow ventricular assist device under pulsatile conditions

High-speed visualization of disturbed pathlines in axial flow ventricular assist device under pulsatile conditions

Long‐term ungrounded cable support for short‐to‐shield syndrome

The Use of Eptifibatide Alone or in Combination With Heparin or Argatroban for Suspected Thrombosis in Patients With Left Ventricular Assist Devices

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