Hemolysis from Aortic Regurgitation Mimicking Pump Thrombosis in a Patient with a HeartMate II Left Ventricular Assist Device

Gopalan, Radha; Arabía, Francisco A.; Noël, Pierre; Chandrasekaran, Krishnaswamy

doi:10.1097/mat.0b013e31824708a8

Cited by 15 publications

(4 citation statements)

References 7 publications

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“…These parameters are strongly associated with the hyperdynamic circulation, which can be caused by a variety of reasons, such as dehydration, aortic regurgitation, and increased pump speed. Of note, the restoration of blood flow into the ascending aorta post LVAD implantation, may affect the function of the aortic valve due to an increase in afterload creating a local circuit where blood leaks backward into the pump[ 19 ]. As a consequence, red blood cells are exposed to high mechanical shear forces caused by the blood-pump interface and hemolysis becomes an unavoidable complication.…”

Section: Etiologymentioning

confidence: 99%

Comprehensive review of hemolysis in ventricular assist devices

Papanastasiou¹,

Kyriakoulis²,

Theochari³

et al. 2020

WJC

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Ventricular assist devices (VADs) have played an important role in altering the natural history of end-stage heart failure. Low-grade hemolysis has been traditionally described in patients with VADs, indicating effective device functionality. However, clinically significant hemolysis could be crucial in terms of prognosis, calling for prompt therapeutic actions. The absence of solid and widely approved diagnostic criteria for clinically significant hemolysis, render the utilization of hemolysis laboratory markers challenging. Hemolysis incidence varies (5%-18%) depending on definition and among different VAD generations, being slightly higher in continuous-flow devices than in pulsatile devices. Increased shear stress of red blood cells and underlying device thrombosis appear to be the main pathogenetic pathways. No certain algorithm is available for the management of hemolysis in patients with VADs, while close clinical and laboratory monitoring remains the cornerstone of management. Imaging examinations such as echocardiography ramp test or computed tomography scan could play a role in revealing the underlying cause. Treatment should be strictly personalized, including either pharmacological (antithrombotic treatment) or surgical interventions.

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Section: Etiologymentioning

confidence: 99%

Comprehensive review of hemolysis in ventricular assist devices

Papanastasiou¹,

Kyriakoulis²,

Theochari³

et al. 2020

WJC

View full text Add to dashboard Cite

show abstract

“…The underlying mechanisms of this alteration of the aortic root biomechanics include repetitive microtrauma of the valvular endothelium and consequently commissural fusion, tissue remodelling and ultimately valvular incompetence. [ 80 – 82 ] Other risk factors associated with the development of AR include small body surface area, older age and being female. It is important to assess the aortic valve prior to LVAD implantation, and a concomitant procedure should be performed in the presence of at least moderate AR.…”

Section: Monitoring For Lvad Complicationsmentioning

confidence: 99%

Invasive Haemodynamic Assessment Before and After Left Ventricular Assist Device Implantation: A Guide to Current Practice

González¹,

Callan

2021

Interv Cardiol

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Mechanical circulatory support for the management of advanced heart failure is a rapidly evolving field. The number of durable long-term left ventricular assist device (LVAD) implantations increases each year, either as a bridge to heart transplantation or as a stand-alone ‘destination therapy’ to improve quantity and quality of life for people with end-stage heart failure. Advances in cardiac imaging and non-invasive assessment of cardiac function have resulted in a diminished role for right heart catheterisation (RHC) in general cardiology practice; however, it remains an essential tool in the evaluation of potential LVAD recipients, and in their long-term management. In this review, the authors discuss practical aspects of performing RHC and potential complications. They describe the haemodynamic markers associated with a poor prognosis in patients with left ventricular systolic dysfunction and evaluate the measures of right ventricular (RV) function that predict risk of RV failure following LVAD implantation. They also discuss the value of RHC in the perioperative period; when monitoring for longer term complications; and in the assessment of potential left ventricular recovery.

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“…Hemolysis after LVAD implantation is associated with an extremely high 1-year mortality that is more than two times greater than that observed for patients (HeartMate II) who do not have hemolysis [ 45 ]. Increased shear stress on red blood cells as they pass through the device is the main mechanism for hemolysis and is usually caused by malpositioning or migration of the device cannula; kinking or pannus on the outflow cannula and graft thrombus formation within the pump, on the inlet and outlet stators (but not the rotor); or aortic insufficiency [ 46 ]. Patients can also have anemia without bleeding, which is accompanied by increased bilirubin, LDH, and plasma free hemoglobin levels and an undetectable haptoglobin level.…”

Section: Symptom Approachmentioning

confidence: 99%

Mechanical circulatory assist devices: a primer for critical care and emergency physicians

et al. 2016

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Mechanical circulatory assist devices are now commonly used in the treatment of severe heart failure as bridges to cardiac transplant, as destination therapy for patients who are not transplant candidates, and as bridges to recovery and "decision-making". These devices, which can be used to support the left or right ventricles or both, restore circulation to the tissues, thereby improving organ function. Left ventricular assist devices (LVADs) are the most common support devices. To care for patients with these devices, health care providers in emergency departments (EDs) and intensive care units (ICUs) need to understand the physiology of the devices, the vocabulary of mechanical support, the types of complications patients may have, diagnostic techniques, and decision-making regarding treatment. Patients with LVADs who come to the ED or are admitted to the ICU usually have nonspecific clinical symptoms, most commonly shortness of breath, hypotension, anemia, chest pain, syncope, hemoptysis, gastrointestinal bleeding, jaundice, fever, oliguria and hematuria, altered mental status, headache, seizure, and back pain. Other patients are seen for cardiac arrest, psychiatric issues, sequelae of noncardiac surgery, and trauma. Although most patients have LVADs, some may have biventricular support devices or total artificial hearts. Involving a team of cardiac surgeons, perfusion experts, and heart-failure physicians, as well as ED and ICU physicians and nurses, is critical for managing treatment for these patients and for successful outcomes. This review is designed for critical care providers who may be the first to see these patients in the ED or ICU.

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Hemolysis from Aortic Regurgitation Mimicking Pump Thrombosis in a Patient with a HeartMate II Left Ventricular Assist Device

Cited by 15 publications

References 7 publications

Comprehensive review of hemolysis in ventricular assist devices

Comprehensive review of hemolysis in ventricular assist devices

Invasive Haemodynamic Assessment Before and After Left Ventricular Assist Device Implantation: A Guide to Current Practice

Mechanical circulatory assist devices: a primer for critical care and emergency physicians

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