Search

Background Thrombosis is an uncommon, but severe complication of left ventricular assist devices (LVADs). Objectives This study analyzed experience with obstruction of blood flow through the LVAD with the purpose of developing optimal diagnosis and treatment of LVAD-related thrombosis. Methods Between October 2009 and July 2015, a total of 652 LVAD were implanted in 557 patients. Blood flow abnormalities in patients with LVAD (n = 524) were identified and classified as “high-power” and “low-flow” events. Results Three types of late blood flow obstructions were identified: 1) pre-pump via thrombus obstructing the inflow cannula (26 events; 0.037 events per patient-year); 2) intra-pump (70 events; 0.1 events per patient-year); and 3) post-pump via thrombosis of the outflow graft or stenosis of the anastomosis to the aorta (4 events; 0.006 events per patient-year). Pre-pump obstruction was treated by washout maneuver in 9 cases (success rate, 100%), thrombolysis in 9 patients (success rate, 56%), and pump exchange in 9 cases (success rate, 100%); 1 patient died without treatment and 2 were weaned from LVAD. Intra-pump obstruction was treated by thrombolysis (n = 9; success rate, 33%), pump exchange (n = 53; success rate, 94%), and removal due to myocardial recovery (n = 3; success rate, 100%); 7 patients died without treatment and parameters spontaneously normalized in 2 cases. Post-pump obstruction was treated in 2 patients by stenting (success rate, 100%), and was left untreated in 2 cases. Conclusions We identified 3 types of LVAD-related blood flow obstruction, and developed an algorithm for optimal diagnosis and treatment.

All studies on Mechanical Circulatory Support MCS for acute myocardial infarction related cardiogenic shock AMICS focused on its impact on in-hospital mortality; however, few data about its role on myocardial recovery are available. Retrospective study on 64 selected patients with AMI-CS and

We thank Dr. Iacovoni and colleagues for their positive comments. We agree with them that a “ramp test” for the HeartWare HVAD (HeartWare, Framingham, Massachusetts) is not standardized. However, we performed a short version, increasing the revolutions per minute (rpm) from 2,200 to up to 3