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Identification of characteristics, risk factors, and predictors of recurrent LVAD thrombosis

  • \(\bf Background\) Redictors of repetitive left-ventricular assist device (LVAD)-thrombosis have not been studied yet. \(\bf Methods\) We identified predictors of recurrent LVAD thrombosis in HeartWare (HVAD) patients in a long-term study from 2010 until 2020. We included all patients with two or more thrombolysis treatments for repetitive HVAD thrombosis and effectiveness of thrombolytic therapy was defined as freedom from stroke, death, another HVAD thrombosis, or surgical device exchange within 30 days after the event. Study endpoints also include all-cause mortality and heart transplantation. \(\bf Results\) A total of 534 HVAD implantations have been screened, and 73 patients (13.7%) developed first HVAD thrombosis after a median of 10 months (IQR; 6–21 months). 46 of these patients had effective thrombolysis in 71.7% (\(\it n\) = 33/46). After a median of 14 months (IQR 4–32 months) follow-up, 17 patients (51.5%) had developed a second HVAD thrombosis and all were treated with t-PA therapy again, resulting in effectiveness in 76.5% (\(\it n\) = 13/17). The four patients with ineffective t-PA therapy underwent subsequent surgical HVAD exchange. Multiple Cox regression model analysis revealed time interval between HVAD implantation and first thrombosis as an independent risk factor of recurrent thrombosis (HR, 0.93, 95% CI 0.87–0.99, \(\it p\) = 0.031). Kaplan–Meier analysis at 3 year follow-up showed no significant difference in overall survival for recurrent vs non-recurrent thrombosis groups (log-rank test, \(\it p\) = 0.959). \(\bf Conclusion\) Recurrent HVAD thrombosis mostly appears within 12 months after first thrombosis. Systemic t-PA therapy for recurrent pump thrombosis seems safe, achieving comparable effectiveness rates to initial t-PA therapy. Survival does not differ between patients with or without recurrent HVAD thrombosis.

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Metadaten
Author:Takayuki GyotenORCiDGND, Michiel MorshuisGND, Sebastian Rojas HernandezORCiDGND, Marcus-André DeutschGND, René SchrammGND, Jan GummertORCiDGND, Henrik FoxORCiDGND
URN:urn:nbn:de:hbz:294-95691
DOI:https://doi.org/10.1007/s10047-020-01228-2
Parent Title (English):Journal of artificial organs
Subtitle (English):conditions in HeartWare devices
Publisher:Springer
Place of publication:Tokyo
Document Type:Article
Language:English
Date of Publication (online):2023/01/10
Date of first Publication:2020/12/18
Publishing Institution:Ruhr-Universität Bochum, Universitätsbibliothek
Tag:HeartWare; LVAD; Pump thrombosis; Surgical pump exchange; Thrombolysis; t-PA
Volume:24
First Page:173
Last Page:181
Note:
Dieser Beitrag ist auf Grund des DEAL-Springer-Vertrages frei zugänglich.
Institutes/Facilities:Herz- und Diabeteszentrum NRW, Klinik für Thorax- und Kardiovaskularchirurgie
Dewey Decimal Classification:Technik, Medizin, angewandte Wissenschaften / Medizin, Gesundheit
open_access (DINI-Set):open_access
Licence (English):License LogoCreative Commons - CC BY 4.0 - Attribution 4.0 International