Risk of Thrombus Formation in Patients on Mechanical Circulatory Support with POLVAD-MEV

Abstract

Background Congestive heart failure is a challenging problem due to increasing prevalence in developed countries. Patients admitted due to decompensated congestive heart failure symptoms who do not respond to medical treatment require mechanical circulatory support. Patients with biventricular failure are at particularly high mortality risk. Material/Methods We analyzed the function of 49 pumps (POLVAD-MEV, FRK Intra-cordis, Poland) implanted to rescue INTERMACS 1 and 2 profile patients referred to our department due to severe congestive heart failure. All patients were waiting for heart transplantation and were readmitted due to acute decompensations of congestive biventricular heart failure with resistance to medical therapy. Results During the observational period, there were no technical problems in pump function. The mean duration of pump therapy was 30.6±8.3 (5–49) days. The risk for right-sided pump complications included clots formation on the following parts of the pump: outflow tract (1, 2%), membrane (13, 27%), dome (6, 12.5%), and periphery (1, 2%). The overall risk for device thrombosis was 41%. The risk for thromboembolic complications was CRP-dependent regarding conglomerates of fibrin and platelets formation (p<0.05). The risk for left-sided pump complications included clots formation on the outflow tract (1, 2%), membrane (9, 19%) and dome (3, 6%). The overall risk for device thrombosis was 27%. The risk for clots formation on the membrane ( P <0.05) and dome of the pump depended on time ( P <0.07). Conclusions Mechanical circulatory support with a paracorporeal pump is a safe option for biventricular heart dysfunction as a bridge to heart transplantation. The risk for thrombi formation is relatively high but acceptable within 30 days after implantation.

Increased Plasma Concentrations of Extracellular Vesicles Are Associated with Pro-Inflammatory and Pro-Thrombotic Characteristics of Left and Right Ventricle Mechanical Support Devices

“…In patients with POLVAD, the pumps’ replacement during the POLVAD function was related to visual signs of thrombus formation on paracorporeal chambers observed during daily controls [ 11 ].…”

“…Pulsatile pneumatic pumps presented optimal results in children [ 9 ] including pulmonary hypertension reversal and satisfactory post-transplantation survival. The comparable results between the use of axial pumps and paracorporeal pulsatiles were presented in adults [ 10 ], though the increased risk for thrombus formation required frequent (every 30 days) pumps exchange [ 11 ] and in-hospital stays are of the greatest concern.…”

In Vitro and In Vivo Testing of Stereolithography (SLA)-Manufactured Haemocompatible Photopolymers for Blood Pump

“…It will enable an extension of LVADs to broader patient populations [12], including future strategies related to minimally invasive implantable devices inserted through the femoral artery. Taking into account the existing data [13][14][15][16][17][18][19][20][21][22], it is evident that the problem of thrombus formation could be avoided through the use of novel hybrid materials and engineering methods based on so-called additive manufacturing technology [23][24][25][26][27]. It allows almost complete freedom of the geometric design of the rotor shape providing proper long-term contact with the blood [28].…”