Early Pump Thrombosis Detection Algorithm in Patients Implanted with Heartware Pump

Abstract

Purpose: Early graft dysfunction (EGD) is a major cause of morbidity and mortality following heart transplantation (HT). Severe EGD often includes the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Studies evaluating its effectiveness are mostly single centre observations with variable outcomes. This systematic review and metaanalysis appraises the available evidence and evaluates prognosis in HT patients with EGD requiring VA-ECMO. Methods: We conducted a systematic search of Ovid Medline, Embase and the Cochrane databases to 05/15/2020. Studies of adults who received VA-ECMO during their index hospitalization after HT and reported on mortality at any timepoint were included. We included observational studies published after 2009, in any language, as abstracts or full texts. Outcomes of interest were short-term mortality, 1-year mortality and VA-ECMO complications. We used QUIPS to assess risk of bias and GRADE to assess the quality of the evidence. Data was pooled using random-effects models. Results: We included 50 studies of 1472 patients with 504 short-term mortality events. Most studies were retrospective (94%), single centre (88%), and at low/acceptable risk of bias overall (76%). Pooled short-term mortality was 33% (95%CI: 27-38%, I 2 =76%) and 1-year mortality was 46% (95%CI: 37-54%, I 2 =81%). Risk of bias, publication type, recruitment timeframe, and use of VA-ECMO for only primary graft dysfunction as per the ISHLT definition did not explain heterogeneity in subgroup analyses. Reported VA-ECMO complications were 38% (95%CI: 27-49%) for dialysis, 36% (95%CI: 26-47%) for bleeding, 22% (95%CI: 14-31%) for infection and 5% (95%CI: 1-10%) for limb ischemia. Conclusion: One-third of HT patients with EGD supported with VA-ECMO are at risk of short-term death. An individual patient data metaanalysis is warranted to further understand the mortality risk and gain insight into risk factors associated with outcomes in this population.

Early detection of HVAD pump thrombosis based on technical analysis and power consumption measurements

“…Taking this into consideration, we decided to develop an algorithm capable of early thromboembolism detection, based on parameters monitored by implanted HVAD. Our results were reported at the International Society for Heart and Lung Transplantation 2021 annual meeting, 15 and this work explains in detail our methodology. With this work we also wanted to internally validate our algorithm.…”