Outcomes of Repeat Left Ventricular Assist Device Exchange

Abstract

Implantable continuous-flow left ventricular assist devices (CF-LVADs) are used for long-term LV support in bridging patients to heart transplantation or as destination therapy. With prolonged support times, some patients will have repeat complications necessitating multiple device exchanges. To elucidate the safety and efficacy of repeat device exchange, we retrospectively reviewed data from 25 patients who underwent two or more CF-LVAD implantations between July 2005 and August 2017. Indications for exchange were thrombus/hemolysis (n = 8, 32%), electromechanical device malfunction (n = 14, 56%), and infection (n = 3, 12%). The implanted devices were the HeartMate II (n = 13, 52%), the HeartWare HVAD (n = 11, 44%), and the Jarvik 2000 (n = 1, 4%). Average hospital length of stay was 44 days (range 4–221 days), and 17 patients (68%) survived to discharge. Average duration of support after the most recent LVAD implantation was 802 days (range 1–3,229 days). Overall survival was 72% at 1 year and 60% at 2 years. Postoperative complications included respiratory failure in five patients (20%), device infection in five (20%), bleeding requiring reoperation in four (16%), neurologic dysfunction in four (16%), and acute renal failure in two (8%). Overall, our data suggest that repeat LVAD exchange is a feasible option for patients with recurrent device-related complications.

Interventional Microbubble Enhanced Sonothrombolysis on Left Ventricular Assist Devices

“…It is the first time that we adopt the IST to treat the thrombosis on LVAD. Here, we review clinical studies about thrombolytic technologies on implantable and interventional devices in recent years [ 2 , 3 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] and compare the IST with other currently used thrombolytic technologies, including medical therapy, pump exchange, sonothrombolysis, washout maneuver, and mechanical thrombectomy. Safety and efficiency are focused on in the evaluation.…”

“…However, it has the incidence of hemorrhagic stroke, [ 2 , 3 , 15 , 16 , 17 , 18 , 19 , 20 ] and need a relative long treatment time, usually >3 h. [ 2 ] Pump exchange is an urgent treatment, but it has a high surgical risk because most of the patients can't suffer another reopen heart surgery. [ 21 , 22 , 23 , 24 , 25 , 26 ] Washout maneuver is used to remove the thrombus at the inlet of LVAD. Although it shows a good success ratio, the risk is still high because the thrombus washed from LVAD will enter other organs.…”

Infection following CF-LVAD exchange for non-infectious indications: A systematic review and meta-analysis

“…9 A more recent report has shown that exchanges were performed for treatment of thrombus/hemolysis in 32%, electromechanical malfunction in 56%. 10 These CF-LVAD-related complications are considered relatively common adverse events, especially for those who receive CF-LVADs for destination therapy as patients on longer term support are likely to encounter problems with prolonged therapy. Generally, pump thrombosis occurs in approximately 10% of HM2 per year; a major factor limiting device durability.…”

“…16 Nevertheless, device exchange puts patients at increased risk for complications and mortality risk increases with each subsequent pump replacement. 10 While it may be expected that patients who undergo exchange for infection are at risk for future infections following CF-LVAD exchange, it is not as intuitive when patients who required exchange for non-infectious etiologies present with infections following CF-LVAD exchange. As many different variables may have contributed to developing infection, further studies are warranted to help identify the characteristics of device exchange that attribute to infection post-exchange.…”

Systemic thrombolysis in the management of pump thrombosis in patients with left ventricular assist devices

“…If PT occurs, the available treatment options are heart transplant, device exchange, intensification of anticoagulant treatment and/or systemic thrombolysis. Heart transplant is not an option in DT patients and (urgent) pump exchange implies major surgery in a vulnerable patient population with considerable surgical risk ( 2 ), leaving systemic thrombolysis as the main treatment option ( 3 ). This study aims to evaluate our experience in treating DT LVAD patients with PT by means of a structured systemic thrombolysis protocol.…”