Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
Yale University School of Medicine, New Haven, Connecticut.
Ann Thorac Surg. 2013 Oct;96(4):1259-1265. doi: 10.1016/j.athoracsur.2013.05.081. Epub 2013 Aug 20.
Thrombosis of the HeartMate II (HM2 [Thoratec Corporation, Pleasanton, CA]) is a potentially devastating complication. While attention has been focused on anticoagulation strategies to prevent this complication, the impact of surgical technique has not been assessed.
Patients undergoing HM2 implantation at two institutions were reviewed. Pump thrombosis (PT) was defined as a clinical syndrome that included more than 30% elevation in pump power, more than 30% elevation in lactate dehydrogenase, and greater than 20% decrease in hemoglobin with the presence of thrombus in the HM2 stator or rotor, or both, at explant or autopsy. A blinded clinician reviewed dimensions and angles of the HM2 obtained from chest x-ray films. Patients demonstrating PT were compared with patients having normal function.
Of the 49 patients reviewed, 11 (22.4%) displayed evidence of PT at a median of 42 days after HM2 implantation. Patient with PT had greater acute angulation of the HM2 inflow cannula immediately postoperatively (48.2 ± 6.8 versus 65.4 ± 9.2 degrees, p < 0.001) and after 30 days (50.1 ± 8.0 versus 65.1 ± 9.9 degrees, p < 0.001). Pump pocket depth was lower in the PT group immediately after HM2 implantation (107.0 ± 41.9 versus 144.3 ± 20.3 cm, p < 0.001) and after 30 days (86.0 ± 39.1 versus 113.1 ± 25.4 cm, p = 0.02). Patients with evidence of PT did not have a decrease in end-diastolic diameter (76 ± 9 versus 70 ± 15 mm, p = 0.24) whereas patients in the normal function group had effective remodeling of the left ventricle (70 ± 10 versus 56 ± 12 mm, p = 0.01).
Meticulous surgical technique, which necessitates creating an adequately sized pump pocket and appropriately directing the inflow cannula at the time of operation, may reduce the risk of PT.
心脏辅助装置 II 型（HM2[美国加利福尼亚州普莱森顿市 Thoratec 公司制造]）血栓形成是一种潜在的灾难性并发症。虽然人们一直关注抗凝策略以预防这种并发症，但手术技术的影响尚未得到评估。
在两个机构接受 HM2 植入的患者进行了回顾性研究。泵血栓形成（PT）定义为一种临床综合征，包括泵功率升高超过 30%，乳酸脱氢酶升高超过 30%，血红蛋白降低超过 20%，同时在 HM2 定子或转子上存在血栓，或两者均存在，在取出或尸检时。一位盲法临床医生对从胸部 X 射线片中获得的 HM2 尺寸和角度进行了评估。将发生 PT 的患者与功能正常的患者进行了比较。
在 49 例患者中，有 11 例（22.4%）在 HM2 植入后中位时间 42 天出现 PT 证据。PT 患者术后即刻（48.2 ± 6.8 与 65.4 ± 9.2 度，p < 0.001）和术后 30 天（50.1 ± 8.0 与 65.1 ± 9.9 度，p < 0.001）HM2 流入管的急性角度更大。PT 组患者 HM2 植入后即刻（107.0 ± 41.9 与 144.3 ± 20.3 cm，p < 0.001）和术后 30 天（86.0 ± 39.1 与 113.1 ± 25.4 cm，p = 0.02）的泵袋深度较低。PT 患者的舒张末期直径没有减少（76 ± 9 与 70 ± 15 mm，p = 0.24），而功能正常组患者的左心室有效重塑（70 ± 10 与 56 ± 12 mm，p = 0.01）。
细致的手术技术，包括在手术时创建足够大小的泵袋并适当引导流入管，可能会降低 PT 的风险。
