High level of cerebral microembolization in patients supported with the DeBakey left ventricular assist device

Thoennissen, Nils H.; Schneider, Michael; Allroggen, A.; Ritter, Martin; Dittrich, Ralf; Schmid, Çhristof; Scheld, Hans H.; Ringelstein, E. B.; Nabavi, Darius G.

doi:10.1016/j.jtcvs.2005.02.068

Cited by 30 publications

(25 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The excessive bleeding was possibility related to the high doses of anticoagulants and antiplatelet medications that were necessary to avoid thrombosis. After modifying the internal surface of the pump with a heparin coating, thromboembolism still occurred at an unacceptable rate [17], indicating that possibly the blood flow pattern and shear may play a greater role in thrombus formation than biomaterial surface interactions.…”

Section: Hematologic Events Associated With Continuous Blood Flowmentioning

confidence: 99%

Hematologic Effects of Continuous Flow Left Ventricular Assist Devices

Slaughter

2010

J. of Cardiovasc. Trans. Res.

104

View full text Add to dashboard Cite

The extent of hematologic effects of the new continuous flow left ventricular assist devices (CF-LVAD) has not been studied. Recent clinical studies have demonstrated that hemolysis and thrombosis are not common during CF-LVAD support, however, the incidence of bleeding remains a concern. The rate of postoperative bleeding is similar to that of the prior generation pulsatile LVAD, but gastrointestinal bleeding due to angiodysplasia and arteriovenous malformations is more common and appears to be related to the blood flow rheology of these devices. New evidence suggests that acquired von Willebrand's disease develops in some patients due to the reduction in high molecular weight (HMW) multimers of von Willebrand's factor (vWF). Similar to acquired von Willebrand's disease seen in patients with aortic stenosis, the shear stress of the CF-LVAD may cause proteolysis of the HMW multimers of vWF. In addition to acquired von Willebrand's disease, there is activation of the fibrinolytic system and a loss of platelet numbers and function during CF-LVAD support. The hematologic responses during CF-LVAD support are constantly changing, and antiplatelet therapy may need to be adjusted accordingly. Considerable research is needed to better define the complex hematologic effects during CF-LVAD support. Screening of patients for angiodysplasia and von Willebrand's disease before CF-LVAD implant may allow for effective preemptive treatment. Because bleeding causes significant morbidity for this population, more effective treatment strategies need to be developed.

show abstract

Section: Hematologic Events Associated With Continuous Blood Flowmentioning

confidence: 99%

Hematologic Effects of Continuous Flow Left Ventricular Assist Devices

Slaughter

2010

J. of Cardiovasc. Trans. Res.

104

View full text Add to dashboard Cite

show abstract

“…In patients undergoing cardiopulmonary bypass, an association between a higher rate of microembolic signals during cardiac surgery and postsurgical neurologic dysfunction has been described [19,20]. The clinical relevance of detecting microemboli is relatively unclear; this phenomenon is mostly unrelated to the development of clinically significant adverse neurologic events in LVAD (including HeartMate II) patients [21][22][23]. However, one study of Novacor LVAD recipients showed that the number of microembolic signals was associated with the incidence of embolic complications; the authors of that study felt that the high negative predictive value of microembolic signals may help identify LVAD recipients with a low risk of thromboembolism [24].…”

Section: Anticoagulation Management: Current Strategiesmentioning

confidence: 99%

The Biological Basis of Thrombosis and Bleeding in Patients with Ventricular Assist Devices

Lee

2008

J. of Cardiovasc. Trans. Res.

View full text Add to dashboard Cite

The clinical success of left ventricular assist devices (LVADs) has been tempered by significant hemorrhagic and thromboembolic complications. In the case of LVADs, where the biomaterial is in direct contact with the blood circulation, significant changes in systemic immunologic and thrombostatic functions have been well documented. Although further investigation is warranted, significant advances have been made in both cellular biology and LVAD technology to better understand the delicate balance between the procoagulant milieu predisposing to thrombosis and the risks of both surgical and non-surgical bleeding.

show abstract

“…[32][33][34][35][36][37][38][39][40] A higher amount of MESs corresponds to thromboembolic events in patients with the Novacor N100 LVAD, 32,34,37 but not in patients with a DeBakey device. 38,40 Patients with the Novacor N100 device and antithrombotic therapy in addition to anticoagulation (eg, antiplatelet agents) had significantly fewer MESs and thromboembolic events. 37 Again, this phenomenon could not be demonstrated in patients with a DeBakey device.…”

Section: Mess In Lvadsmentioning

confidence: 99%

“…37 Again, this phenomenon could not be demonstrated in patients with a DeBakey device. 38 MESs in DeBakey LVAD carriers could be abolished in part by oxygen inhalation, indicating that a substantial number of these MESs are gaseous in origin 38,39 (see also Table 2). However, the use of time domain analysis to differentiate the mixed composition of gaseous and solid emboli was unsuccessful.…”

Section: Mess In Lvadsmentioning

confidence: 99%

Occurrence and Clinical Impact of Microembolic Signals During or After Cardiosurgical Procedures

Dittrich

Ringelstein

2008

Stroke

Self Cite

View full text Add to dashboard Cite

Background and Purpose-Microembolic signals (MESs) are detectable within the transcranial Doppler frequency spectrum downstream from vascular atherothrombotic or cardiothrombotic lesions. A frequent occurrence of MESs has also been shown during bypass surgery or after mechanical valve implantation. We sought to compile the knowledge on MES prevalence, the clinical impact of these cardiogenic MESs, and microemboli composition. Summary of Review-We performed a systematic MEDLINE search and summarized the currently available literature about MESs during or after cardiosurgical procedures for this state-of-the-art report. Conclusions-The nature of cardiogenic MESs is heterogeneous, and their prevalence is highly variable, reflecting their different origin from a broad spectrum of cardiosurgical conditions. The occurrence and number of MESs during cardiac catheterization and percutaneous coronary angioplasty seem to have a clinical impact but need to be explored further.In patients with prosthetic heart valves, in those with left ventricular assist devices, and during cardiac surgery, the occurrence of MESs has an important clinical impact, and MES monitoring has proven its reliability.

show abstract

High level of cerebral microembolization in patients supported with the DeBakey left ventricular assist device

Cited by 30 publications

References 33 publications

Hematologic Effects of Continuous Flow Left Ventricular Assist Devices

Hematologic Effects of Continuous Flow Left Ventricular Assist Devices

The Biological Basis of Thrombosis and Bleeding in Patients with Ventricular Assist Devices

Occurrence and Clinical Impact of Microembolic Signals During or After Cardiosurgical Procedures

Contact Info

Product

Resources

About