Incidence of increases in pump power use and associated clinical outcomes with an axial continuous-flow ventricular assist device

Steffen, Robert; Soltesz, Edward G.; Miracle, Kimberly; Lee, Sang-Jin; Mountis, Maria; Moazami, Nader

doi:10.1016/j.healun.2013.08.020

Cited by 5 publications

(2 citation statements)

References 3 publications

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“…Recently, Starling et al reported an increasing rate of Thoratec HeartMate II pump thrombosis, which was preceded by increasing lactate dehydrogenase (LDH), and was associated with substantial morbidity and mortality [ 16 ]. Other reports showed a strong association of haemolysis with increased pump power and with partial or complete LVAD thrombosis [ 17 , 18 ]. The current guidelines of the International Society for Heart and Lung Transplantation (ISHLT) advise to follow up haemolysis as a sign of thrombosis [ 7 ].…”

Section: Introductionmentioning

confidence: 97%

Haemolysis as a first sign of thromboembolic event and acute pump thrombosis in patients with the continuous-flow left ventricular assist device HeartMate II

et al. 2015

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BackgroundDespite advances in pump technology, thromboembolic events/acute pump thrombosis remain potentially life-threatening complications in patients with continuous-flow left ventricular assist devices (CF-LVAD). We sought to determine early signs of thromboembolic event/pump thrombosis in patients with CF-LVAD, which could lead to earlier intervention.MethodsWe analysed all HeartMate II recipients (n = 40) in our centre between December 2006 and July 2013. Thromboembolic event/pump thrombosis was defined as a transient ischaemic attack (TIA), ischaemic cerebrovascular accident (CVA), or pump thrombosis.ResultsDuring median LVAD support of 336 days [IQR: 182–808], 8 (20 %) patients developed a thromboembolic event/pump thrombosis (six TIA/CVA, two pump thromboses). At the time of the thromboembolic event/pump thrombosis, significantly higher pump power was seen compared with the no-thrombosis group (8.2 ± 3.0 vs. 6.4 ± 1.4 W, p = 0.02), as well as a trend towards a lower pulse index (4.1 ± 1.5 vs. 5.0 ± 1.0, p = 0.05) and a trend towards higher pump flow (5.7 ± 1.0 vs. 4.9 ± 1.9 L m, p = 0.06).The thrombosis group had a more than fourfold higher lactate dehydrogenase (LDH) median 1548 [IQR: 754–2379] vs. 363 [IQR: 325–443] U/L, p = 0.0001). Bacterial (n = 4) or viral (n = 1) infection was present in 5 out of 8 patients. LDH > 735 U/L predicted thromboembolic events/pump thrombosis with a positive predictive value of 88 %.ConclusionsIn patients with a CF-LVAD (HeartMate II), thromboembolic events and/or pump thrombosis are associated with symptoms and signs of acute haemolysis as manifested by a high LDH, elevated pump power and decreased pulse index, especially in the context of an infection.

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Section: Introductionmentioning

confidence: 97%

Haemolysis as a first sign of thromboembolic event and acute pump thrombosis in patients with the continuous-flow left ventricular assist device HeartMate II

et al. 2015

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“…It has been shown that primarily rapid changes in pump parameters might be indicative of pump thrombosis, low volume status, or hemolysis. 2,16 In addition, disproportionately high pump speeds are associated with leftward movement of the septum, increased tricuspid valve regurgitation, and with longer lengths of hospital stays post-implant. 3,4 Decreased PI has also been demonstrated to be associated with a higher risk of gastrointestinal bleeding.…”

Section: Introductionmentioning

confidence: 99%

Left ventricle assist device pulsatility index at the time of implantation is associated with follow-up pulmonary hemodynamics

et al. 2020

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HeartMate II left ventricular assist device controllers provide data including pulsatility index, reflecting the relationship between pump function and hemodynamics. We propose that a higher pulsatility index at hospital discharge following implant may be associated with less vascular congestion and improved clinical outcomes. A retrospective analysis of 40 patients (age 59.2 ± 10.3 years) supported with the HeartMate II devices was conducted. Data revealed moderate Pearson correlations between pulsatility index at discharge and right atrial pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, mean pulmonary arterial pressure, and pulmonary capillary wedge pressure, respectively, post-surgery (median of 377 days), demonstrating a stronger relationship when analyzed for the EPC controller (n = 28) only (r = −.57, p < .01; r = −.38, p < .05; r = −.59, p < .01; r = −.47, p = .01 and r = −.53, p < .01, respectively). The pulsatility index derived from the EPC controller was associated with the significant risk of re-hospitalization within 1 and 2 years after the implantation of left ventricular assist device; hazard ratio = 0.557 with 95% confidence interval (0.315–0.983), p = .04 and hazard ratio = .579 (0.341–0.984), p = .04. A higher pulsatility index at discharge was associated with greater volume unloading, lower pulmonary pressures, and lower risk of all-cause re-hospitalizations within 1 and 2 years post-surgery. As such, pump-derived data may provide additional value in predicting left ventricular assist device hemodynamics.

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Ventricular Assist Device Thrombosis

Sawey

Mankad

Lewis

2018

Cardiovascular Thrombus

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Incidence of increases in pump power use and associated clinical outcomes with an axial continuous-flow ventricular assist device

Cited by 5 publications

References 3 publications

Haemolysis as a first sign of thromboembolic event and acute pump thrombosis in patients with the continuous-flow left ventricular assist device HeartMate II

Haemolysis as a first sign of thromboembolic event and acute pump thrombosis in patients with the continuous-flow left ventricular assist device HeartMate II

Left ventricle assist device pulsatility index at the time of implantation is associated with follow-up pulmonary hemodynamics

Ventricular Assist Device Thrombosis

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