Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita City, Osaka, Japan.
Artif Organs. 2013 Jul;37(7):606-14. doi: 10.1111/aor.12045. Epub 2013 May 20.
Pump thrombosis is one of the major adverse events associated with the use of a left ventricular assist system (LVAS) in patients with advanced heart failure. We investigated the clinical implication of pump replacement because of thrombus formation. This study included 87 patients who underwent implantation of a Nipro (Toyobo) pulsatile extracorporeal LVAS intended as a bridge to transplantation and were alive more than 3 months after implantation. The pump of this device is translucent, and daily evaluation for signs of thrombus formation was performed. Pump replacement was performed for significant thrombus formation that became visible. Data collection including demographics as well as hematologic values were performed 1 day before (baseline) and 3 months after implantation, and all patients were followed for 2 years or until death. At 3 months after LVAS implantation, 41 patients (47.1%) had undergone pump replacement because of pump thrombus. Baseline body surface area <1.63 m(2) was a significant predictor of pump replacement (hazard ratio [HR] 2.15, P = 0.04). At 3 months after implantation, there was a significantly higher incidence of stroke (P < 0.05) as well as a significantly greater decrease in body weight (F = 4.92, P = 0.03) in patients who underwent pump replacement as compared to those without. The 2-year mortality after implantation was 26.4%. Multivariate Cox regression analysis showed that pump replacement within 3 months after implantation was an independent predictor of mortality (HR 2.50, P = 0.03). In conclusion, pump replacement for thrombus formation may have a strong association with worse outcome. Our results reconfirm the clinical importance of device thrombus in the management of LVAS.
泵血栓形成是与晚期心力衰竭患者使用左心室辅助系统（LVAS）相关的主要不良事件之一。我们研究了因血栓形成而进行泵更换的临床意义。这项研究包括 87 名接受尼普（东丽）搏动性体外 LVAS 植入的患者，这些患者被用作移植的桥接，并在植入后存活超过 3 个月。该设备的泵是半透明的，每天都要评估是否有血栓形成的迹象。对于明显可见的血栓形成，会进行泵更换。收集包括人口统计学数据以及血液学值在内的数据，在植入前 1 天（基线）和植入后 3 个月进行，所有患者随访 2 年或直至死亡。在 LVAS 植入后 3 个月，41 名患者（47.1%）因泵血栓形成而进行了泵更换。基线体表面积<1.63m²是泵更换的显著预测因素（风险比[HR]2.15，P=0.04）。植入后 3 个月，行泵更换的患者中风发生率明显较高（P<0.05），体重下降明显更大（F=4.92，P=0.03）。植入后 2 年死亡率为 26.4%。多变量 Cox 回归分析显示，植入后 3 个月内进行泵更换是死亡的独立预测因素（HR 2.50，P=0.03）。总之，因血栓形成而进行泵更换可能与更差的预后密切相关。我们的结果再次证实了设备血栓在 LVAS 管理中的重要性。
