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ventricular assist device thrombosis

D Sarp Beyazpınar, Özgür Ersoy, Bahadır Gültekin, Anar Aliyev, Mert Avsever, H Tankut Akay, Murat Özkan, Atilla Sezgin, Sait Aşlamacı
Heart failure is the one of the biggest health problem in the world. Because of limited donors for heart transplant procedures, the ventricular assist device has become a solution for heart failure therapy. With the increase in number of ventricular assist devices, the incidence of complications has also increased. One of the most important life-threatening complications is ventricular assist device thrombosis. Medical therapy and changes in the ventricular assist device are the main therapy methods for ventricular assist device thrombosis...
March 2018: Experimental and Clinical Transplantation
Jasmin S Hanke, Günes Dogan, Amelie Zoch, Marcel Ricklefs, Leonhard Wert, Christina Feldmann, Christoph Bara, Malakh Shrestha, Jochen Tillmanns, Tibor Kempf, Johann Bauersachs, Axel Haverich, Jan D Schmitto
BACKGROUND: The HeartMate 3 (HM3; Abbott Laboratories, Lake Forest, Ill) left ventricular assist device (LVAD) received its Conformité Européenne mark for Europe in October 2015 and is currently under investigation of the Food and Drug Administration to gain approval in the United States. Within this study, we present the first real-world experiences, 1-year outcomes, and adverse events of a single-center cohort treated with the HM3. METHODS: We prospectively studied midterm results of 27 consecutive patients receiving the HM3 at a single institution...
February 13, 2018: Journal of Thoracic and Cardiovascular Surgery
Per Sundbom, Michael Roth, Hans Granfeldt, Daniel M Karlsson, Henrik Ahn, Fredrik Gustafsson, Laila Hubbert
INTRODUCTION: The use of left ventricular assist device (LVAD) has grown rapidly. Adverse events do continue to occur. In recent years, analysis of LVAD sound recordings emerged as a means to monitor pump function and detect pump thrombosis. The aim of this study was to characterize the sounds from HeartMate II and to evaluate the use of handheld iOS devices for sound recordings. METHOD: Signal analysis of LVAD sound recordings, with dedicated recording equipment and iOS devices, was performed...
March 1, 2018: International Journal of Artificial Organs
Indranee Rajapreyar, Deepak Acharya, José Tallaj, Lauren Hornbuckle, Jessica Sharpton, Joanna Joly, Salpy Pamboukian
Ventricular arrhythmias occurs in 20-50% of patients supported with left ventricular assist devices (LVAD). Ventricular arrhythmias are well tolerated with LVAD support but long-term consequences include worsening right ventricular function. Management of ventricular arrhythmias in LVAD patients includes use of antiarrhythmic agents or ablation. Amiodarone has been used a first-line agent to treat ventricular arrhythmias post-LVAD implantation. Chronic treatment with amiodarone for arrhythmias can result in hyperthyroidism and hypothyroidism in 5-10% of patients...
March 5, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Ina Laura Pieper, Gemma Radley, Abigail Christen, Sabrina Ali, Owen Bodger, Catherine A Thornton
Ventricular assist devices (VADs) are a life-saving form of mechanical circulatory support in heart failure patients. However, VADs have not yet reached their full potential due to the associated side effects (thrombosis, bleeding, infection) related to the activation and damage of blood cells and proteins caused by mechanical stress and foreign materials. Studies of the effects of VADs on leukocytes are limited, yet leukocyte activation and damage including microparticle generation can influence both thrombosis and infection rates...
March 7, 2018: Artificial Organs
Deepak Acharya, Sudeep Aryal, Renzo Loyaga-Rendon, Salpy V Pamboukian, Jose Tallaj, James K Kirklin, William L Holman, Satinder Singh
Optimal left ventricular assist device (LVAD) cannula position is important for adequate ventricular unloading and LVAD function. Poor inflow cannula position predisposes to pump thrombosis, inotrope dependence, and mortality. We describe a novel technique of preoperative left ventricular apex marking using CT guidance and demonstrate in three cases the use of this method to achieve optimal inflow cannula positioning for lateral thoracotomy Heartware LVAD implantation.
February 24, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Amrish Deshmukh, Ankit Bhatia, Emeka Anyanwu, Takeyoshi Ota, Valluvan Jeevanandam, Nir Uriel, Roderick Tung, Cevher Ozcan
This study sought to determine the incidence, predictors, and outcomes of postoperative atrial fibrillation (POAF) in patients undergoing implantation of left ventricular assist devices (LVADs). A retrospective analysis of all patients who underwent LVAD implantation from 2013 to 2014 was conducted. Postoperative AF, survival, and thrombotic complications were evaluated after surgery. A total of 47 patients (mean age, 56.4 ± 12.5 years; 33 male) were included and followed for a median of 331 days. Within 30 days of surgery, 13 (28%) patients developed POAF at mean 7...
February 24, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Erik N Sorensen, Hannah J Voorhees, Lynn M Dees, Si M Pham, Zachary N Kon, Bartley P Griffith, Erika D Feller
There are no evidence-based guidelines for antithrombotic therapy in left ventricular assist device patients. We evaluated the efficacy of a multi-agent, test-guided protocol, which remained consistent throughout our use of the Heartware HVAD. Thrombelastography and PFA-100 guide antiplatelet titration. Goals are normal kaolin thrombelastography maximum amplitude and prolonged PFA-100. We analyzed incidence and rates of nonprocedural bleeding, stroke, and pump thrombosis for all 81 primary Heartware left ventricular assist devices implanted since 2011...
February 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Emeka C Anyanwu, Viktoriya Kagan, Ankit Bhatia, David M Tehrani, Sirtaz Adatya, Gene Kim, Nitasha Sarswat, Valluvan Jeevanandam, Gabriel Sayer, Nir Uriel
There is little data outlining the use of outpatient inotropic medications in patients with existing left ventricular assist devices (LVADs). This case series explores this patient population and seeks to define the indications, complications, and safety of dual support. A retrospective chart review was conducted for all patients on LVAD and then subsequently started on home inotropes post device implant. Eight patients met inclusion criteria. The indications for inotropes were right ventricular failure, aortic insufficiency with biventricular failure, LVAD thrombosis with contraindication to device exchange, and cannula malposition with elevated pulmonary vascular resistance...
February 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Lisa Baumann Kreuziger, Mark S Slaughter, Kartik Sundareswaran, Alan E Mast
Left ventricular assist device (LVAD) thrombosis is a devastating complication that occurs in about 10% of patients despite anticoagulation and antiplatelet treatment. How the thrombus initiates and propagates is unknown. We pathologically and immunohistochemically examined 28 thrombi removed from 17 HeartMate II LVADs. Two groups of thrombi were found: those formed in the inlet/outlet and those on the rotor. The four thrombi found at the inlet (three inlet conduit and one inlet tube) and outlet (three at outlet elbow and one outlet graft) appeared similar and were composed of a loose meshwork of fibrin(ogen), von Willebrand factor, leukocytes, and aggregated platelets...
February 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Rashad Zayat, Mohamed Shoaib, Mohammad Amen Khattab, Usaama Ahmad, Andreas Goetzenich, Christian Stoppe, Ann Christina Foldenauer, Ajay Moza, Heike Schnoering, Rüdiger Autschbach, Lachmandath Tewarie
OBJECTIVES: Haemolysis during left ventricular assist device support is associated with thrombosis. In this retrospective study, we analysed whether low-level haemolysis (LLH) as defined by simultaneously elevated lactate dehydrogenase (LDH) and free haemoglobin (fHb) levels had an impact on thromboembolic and bleeding events and on von Willebrand factor levels in HeartMate II patients. METHODS: After exclusion of patients with LDH >700 U/l and fHb >40 mg/dl at hospital discharge, 79 HeartMate II patients were included...
February 12, 2018: Interactive Cardiovascular and Thoracic Surgery
Jenna N Dietrich, Hasan Kazmi
BACKGROUND: The Impella manufacturer has changed its recommendation for the diluent of the heparinized purge solution from 20% dextrose (D20) to 5% dextrose (D5). This reduced viscosity may result in increased purge solution infusion rates and unfractionated heparin (UFH) exposure. Increased UFH exposure could potentially cause increased bleeding events and may necessitate reduction in UFH concentration in the purge solution. Our objective was to evaluate anticoagulation for patients on Impella pumps receiving heparinized purge solution with D20 or D5 diluents...
January 1, 2018: Journal of Pharmacy Practice
Lorenzo Valerio, Jawaad Sheriff, Phat L Tran, William Brengle, Alberto Redaelli, Gianfranco B Fiore, Federico Pappalardo, Danny Bluestein, Marvin J Slepian
INTRODUCTION: Continuous flow ventricular assist devices (cfVADs) continue to be limited by thrombotic complications associated with disruptive flow patterns and supraphysiologic shear stresses. Patients are prescribed complex antiplatelet therapies, which do not fully prevent recurrent thromboembolic events. This is partially due to limited data on antiplatelet efficacy under cfVAD-associated shear conditions. MATERIALS AND METHODS: We investigated the efficacy of antiplatelet drugs directly acting on three pathways: (1) cyclooxygenase (aspirin), (2) phosphodiesterase (dipyridamole, pentoxifylline, cilostazol), and (3) glycoprotein IIb-IIIa (eptifibatide)...
December 5, 2017: Thrombosis Research
Monica Dobrovie, Ricardo A Spampinato, Elena Efimova, Jaqueline G da Rocha E Silva, Julia Fischer, Michael Kuehl, Jens-Uwe Voigt, Ann Belmans, Agnieszka Ciarka, Fernanda Bonamigo Thome, Valerie Schloma, Yaroslava Dmitrieva, Sven Lehmann, Jochen Hahn, Elfriede Strotdrees, Friedrich-Wilhelm Mohr, Jens Garbade, Anna L Meyer
OBJECTIVES: This study evaluates the impact of untreated preoperative severe mitral valve regurgitation (MR) on outcomes after left ventricular assist device (LVAD) implantation. METHODS: Of the 234 patients who received LVAD therapy in our centre during a 6-year period, we selected those who had echocardiographic images of good quality and excluded those who underwent mitral valve replacement prior to or mitral valve repair during LVAD placement. The 128 patients selected were divided into 2 groups: Group A with severe MR (n = 65) and Group B with none to moderate MR (n = 63, 28 with moderate MR)...
January 16, 2018: European Journal of Cardio-thoracic Surgery
Ankit Jain, Frederick C Cobey
HeartWare is a third-generation continuous flow left ventricular assist device (LVAD) and generates centrifugal pattern of blood flow. In the perioperative setting, interrogating the HeartWare devices is very difficult due to the interference of the Doppler by the impeller frequency and generation of the waterfall artifact. We present a case where using color Doppler a view "inside" the impeller can be seen which corresponds to the centrifugal flow of blood. With time, these images can be looked into in pathological states such as pump thrombosis, to come to a more meaningful conclusion regarding the flow of blood within the centrifugal chamber...
January 2018: Annals of Cardiac Anaesthesia
Erik N Sorensen, Zachary N Kon, Erika D Feller, Si M Pham, Bartley P Griffith
BACKGROUND: We previously investigated preoperative variables associated with qualitative inflow cannula (IFC) malposition in the Heartmate II continuous-flow left ventricular assist device. In this report, we assess IFC malposition quantitatively in recipients of both the Heartmate II and the Heartware and examine its association with device thrombosis. METHODS: Malposition was quantified based on angular deviation from a hypothetical ideal IFC position in two orthogonal computed tomography (CT) imaging planes...
January 3, 2018: Annals of Thoracic Surgery
Mahwash Kassi, Bashar Hannawi, Barry Trachtenberg
PURPOSE OF REVIEW: Acute heart failure continues to be a challenge as there is limited benefit of numerous agents that have been tested. Cardiac resynchronization therapy remains standard of care, yet timing and need for implantable cardiac defibrillator has been brought into question with the recent randomized trials. Several recent advances have been made towards management of heart failure both in drug and device therapy. The purpose of this review is to provide an update on the most important recent studies on heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF)...
March 2018: Current Opinion in Cardiology
Teruhiko Imamura, Ben Chung, Ann Nguyen, Gabriel Sayer, Nir Uriel
Left ventricular assist devices (LVADs) significantly improve outcomes of advanced heart failure patients. However, patients continue to have high readmission rates due to complications ranging from bleeding, thrombosis, heart failure, and infection. Considering that the hallmark benefit of LVAD therapy is improvement in hemodynamics (cardiac unloading and increased cardiac output), hemodynamic assessment on LVAD support is key to better understand these difficult complications and may serve as a tool to resolving them...
December 26, 2017: Journal of Cardiology
Filippo Consolo, Giulia Sferrazza, Giulia Motolone, Rachele Contri, Lorenzo Valerio, Rosalba Lembo, Loris Pozzi, Patrizia Della Valle, Michele De Bonis, Alberto Zangrillo, Gianfranco B Fiore, Alberto Redaelli, Marvin J Slepian, Federico Pappalardo
AIMS: To correlate the dynamics of platelet activation with the development of thromboembolic events in patients with continuous-flow left ventricular assist device (cf-LVAD). METHODS AND RESULTS: The platelet activity state (PAS) assay was utilized to evaluate platelet activation in 68 cf-LVAD patients implanted with the HeartMate II (n = 15, 22%), HeartMate 3 (n = 15, 22%), or HeartWare HVAD (n = 38, 56%). PAS was measured preoperatively, early post-implant, and at long-term follow-up (1, 3, 6, 12, 18, and 24 months post-implant)...
December 28, 2017: European Journal of Heart Failure
Mohammad K Mojadidi, Ahmed N Mahmoud, Akram Y Elgendy, R David Anderson
Ventricular arrhythmia from aortic cusp thrombosis and coronary embolization is a rare complication of left ventricular assist device (LVAD) implantation. In this report, we present a case of acute left main and left anterior descending artery occlusion from embolic aortic cusp thrombi after LVAD implant. The patient presented with chest pain and incessant ventricular tachycardia post-LVAD implant. This was successfully treated by intracoronary thrombolysis, aspiration thrombectomy, and rheolytic thrombectomy...
October 21, 2017: Curēus
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