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Management of Pump Thrombosis in Patients with Left Ventricular Assist Devices

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Abstract

The gradual evolution of left ventricular assist device (LVAD) therapy has resulted in a durable option for patients as either a bridge to transplantation (BTT) or a destination therapy (DT). Outcomes with current continuous-flow devices continue to demonstrate significant patient benefit, not only in enhanced survival but also in improved functional capacity and quality of life. While the lessening of adverse events through time has resulted in more widespread adoption of this therapy, there continues to be unintended consequences, including, most notably, infection, bleeding, and thrombosis. Beginning in 2011, centers and collaborative groups began to observe a significant increase in the incidence of pump thrombosis with the HeartMate II LVAD (Thoratec Corp., Pleasanton, CA, USA). However, this clinical scourge is not limited to the HeartMate II, as the HeartWare Ventricular Assist System (HVAD; HeartWare Inc., Framingham, MA, USA) has also had these same issues, which led to pump modifications and the appreciation of more strict control of blood pressure and anticoagulation with this pump design. We review the current status of the field of mechanical circulatory support in its approach to diagnosis, management, and prevention of LVAD pump thrombosis.

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Acknowledgments

Simon Maltais, John Stulak, and Shashank Sharma have no financial relationships to disclose. All authors participated in major portions of this manuscript. There was no funding source for this work.

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Authors and Affiliations

  1. Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    John M. Stulak & Shashank Sharma

  2. Vanderbilt Heart and Vascular Institute, Nashville, TN, USA

    Simon Maltais

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  1. John M. Stulak
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  2. Shashank Sharma
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  3. Simon Maltais
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Correspondence to John M. Stulak.

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Stulak, J.M., Sharma, S. & Maltais, S. Management of Pump Thrombosis in Patients with Left Ventricular Assist Devices. Am J Cardiovasc Drugs 15, 89–94 (2015). https://doi.org/10.1007/s40256-014-0102-3

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  • DOI: https://doi.org/10.1007/s40256-014-0102-3

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