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• W1997131250 abstract "Left ventricular assist devices (LVAD) are increasingly being used to bridge patients to cardiac transplantation and as permanent therapy for selected patients with endstage heart failure. Compared with pulsatile LVADs (p-LVADs), continuous-flow LVADs (cf-LVADs) demonstrate better survival with fewer device-related complications. Although thrombolytic therapy has been described with axial-flow devices; experience with cf-LVADs thrombosis is limited. The HeartWare system (HeartWare International Inc, Framingham, Mass) is a novel cf-LVAD that is implanted within the pericardial space and that generates up to 10 L/min of flow. 2: A 55 year_old male with a history of dilated cardiomyopathy recieved HeartWare LVAD. He refered to our hospital because on clinical assesment was found to have acute and unexpected symptoms; dyspnea, hematuria and confussion. Admission LVAD speed was 2600 rpm with an estimated flow of 4.8 L/min without excessive pump power. Mean blood pressure was 90 mm Hg. In two days the patient progressed into dyspnea worsened and anemia. LVAD flow increased from 4,8 to >10L/min and power consumption of LVAD was increased from 4,2 watt to 13 watt; without a change in pump speed or blood pressure. Patient. was referred for intraventricular administration of thrombolytics. The LV was accessed via the left femoral artery using a 6F pigtail catheter. Alteplase was administered at a rate of 2mg/min. After 45 minutes LVAD flow reduced to 7,3 L/min and power use was decreased to 6,2 watt. Over a 8-hour period, urine output increased and there was no more hematuria. 24 hours later renal function returned to normal rates. Ventricular assist devices affect the coagulation system. All pumps come into contact with the blood, potentially promoting thrombosis and thromboembolic events. In this situation, anticoagulation is necessary, and this may in turn cause bleeding complications. Furthermore, the VAD itself affects the equilibrium of the coagulation system, which may cause thrombosis or bleeding or even both at the same time. The incidence of bleeding of any cause (requiring red blood cell transfusion or necessitating surgery) with different types of VAD ranges between 0.16 and 2.45 events per patient per year. The incidence of thromboembolic events is 0.05–0.28 events per patient per year. LVAD thrombosis is a potentially life-threatening complication requiring prompt diagnosis and management As nonpulsatile LVADs are increasingly applied in the management of end-stage heart failure, standardization of the percutaneous management of device thrombosis may be necessary." @default.
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• W1997131250 date "2014-04-01" @default.
• W1997131250 modified "2023-09-27" @default.
• W1997131250 title "PP-368 Management of HeartWare Left Ventricular Assist Device Thrombosis Using Intracavitary Thrombolytics" @default.
• W1997131250 doi "https://doi.org/10.1016/j.amjcard.2014.01.399" @default.
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