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. 2016 Feb;24(2):134-42.
doi: 10.1007/s12471-015-0786-2.

Haemolysis as a first sign of thromboembolic event and acute pump thrombosis in patients with the continuous-flow left ventricular assist device HeartMate II

S Akin  1   2 , O I Soliman  1   3 , A A Constantinescu  1 , F Akca  1 , O Birim  4 , R T van Domburg  1 , O Manintveld  1 , K Caliskan  5
Affiliations

Haemolysis as a first sign of thromboembolic event and acute pump thrombosis in patients with the continuous-flow left ventricular assist device HeartMate II

S Akin et al. Neth Heart J. 2016 Feb.

Abstract

Background: Despite advances in pump technology, thromboembolic events/acute pump thrombosis remain potentially life-threatening complications in patients with continuous-flow left ventricular assist devices (CF-LVAD). We sought to determine early signs of thromboembolic event/pump thrombosis in patients with CF-LVAD, which could lead to earlier intervention.

Methods: We analysed all HeartMate II recipients (n = 40) in our centre between December 2006 and July 2013. Thromboembolic event/pump thrombosis was defined as a transient ischaemic attack (TIA), ischaemic cerebrovascular accident (CVA), or pump thrombosis.

Results: During median LVAD support of 336 days [IQR: 182-808], 8 (20 %) patients developed a thromboembolic event/pump thrombosis (six TIA/CVA, two pump thromboses). At the time of the thromboembolic event/pump thrombosis, significantly higher pump power was seen compared with the no-thrombosis group (8.2 ± 3.0 vs. 6.4 ± 1.4 W, p = 0.02), as well as a trend towards a lower pulse index (4.1 ± 1.5 vs. 5.0 ± 1.0, p = 0.05) and a trend towards higher pump flow (5.7 ± 1.0 vs. 4.9 ± 1.9 L m, p = 0.06). The thrombosis group had a more than fourfold higher lactate dehydrogenase (LDH) median 1548 [IQR: 754-2379] vs. 363 [IQR: 325-443] U/L, p = 0.0001). Bacterial (n = 4) or viral (n = 1) infection was present in 5 out of 8 patients. LDH > 735 U/L predicted thromboembolic events/pump thrombosis with a positive predictive value of 88 %.

Conclusions: In patients with a CF-LVAD (HeartMate II), thromboembolic events and/or pump thrombosis are associated with symptoms and signs of acute haemolysis as manifested by a high LDH, elevated pump power and decreased pulse index, especially in the context of an infection.

Keywords: Haemolysis; HeartMate II; Left ventricular assist device (LVAD); Pump thrombosis; Thromboembolic event.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Kaplan-Meyer curve for survival during LVAD support for the thrombosis group (TE/PT+) and the no-thrombosis group (TE/PT−). Patients are censored at heart transplantation and LVAD explantation
Fig. 2
Fig. 2
a Explanted pump inlet rotor in a 54-year-old male (patient no. 9 in Table 3) with acute pump thrombosis. Due to acute pump thrombosis, the patient had acute left- and right-sided heart failure with signs of severe haemolysis and acute renal failure. Macroscopic fresh white and red old thrombus is shown on the rotor, as confirmed by the manufacturer. b LDH course of the 57-year-old male (patient no. 7 in Table 3) presenting with acute pump thrombosis successfully treated with recombinant tissue-plasminogen activator (rt-PA). This patient had several episodes of an abrupt peak of LDH during therapeutic INRs associated with relapsing urinary tract infections (Citrobacter freundii). At the highest LDH peak he developed acute pump thrombosis, which was treated with thrombolytic therapy (alteplase). Dashed line = upper limit of normal value LDH. c Time course of serum LDH (U/L) in a 37-year-old woman (patient no. 5 in Table 3), 6 months on LVAD support, admitted with a ischaemic cerebrovascular event and response to various therapeutic interventions. CVA cerebrovascular accident, INR international normalised ratio, ASA acetylsalicylic acid, iv intravenous. Dashed line = upper limit of normal value LDH
See this image and copyright information in PMC

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