From the *Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; †Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota; and ‡Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
ASAIO J. 2014 Jan-Feb;60(1):9-14. doi: 10.1097/MAT.0000000000000012.
Continuous flow left ventricular assist devices (LVADs) are used with good outcome. However, acute intravascular hemolysis due to thrombus in the pump remains a clinical challenge. We screened for LVAD-related intravascular hemolysis among 115 consecutive patients surviving HeartMateII implantation and investigated the role of medical therapy in resolving the hemolysis. Hemolytic events were identified in 7% of patients, 2-26 months after implant, manifested by peak lactate dehydrogenase (LDH) levels >6 times normal. With the institution of heparin and enhanced antiplatelet therapy, LDH levels receded rapidly reaching a stable trough level near baseline within 2 weeks with the resolution of clinical symptoms except in one patient who required additional therapy with tissue plasminogen activator (tPA). Complications included transient renal failure, one splenic infarct, and a cerebrovascular attack after tPA. The acute event of hemolysis resolved with medical therapy, and all were successfully discharged. However, recurrent hemolysis was common (6/8 patients over the next 1-7 months). At the end of follow-up, three patients were transplanted, one patient died refusing LVAD exchange for recurrent hemolysis, and 4 remained alive on LVAD support. Medical treatment with intensification of anticoagulation can be effective in resolving the acute hemolytic event. However, a definitive long-term strategy should be planned because the recurrence rate is high.
连续流动左心室辅助装置（LVAD）的应用效果良好。然而，由于泵内血栓导致的急性血管内溶血仍然是一个临床挑战。我们在 115 例连续植入 HeartMateII 的患者中筛查了与 LVAD 相关的血管内溶血，并研究了药物治疗在解决溶血方面的作用。溶血事件发生在 7%的患者中，在植入后 2-26 个月，表现为峰值乳酸脱氢酶（LDH）水平超过正常水平的 6 倍。通过使用肝素和增强抗血小板治疗，LDH 水平迅速下降，在 2 周内达到接近基线的稳定谷值，临床症状得到缓解，但有 1 例患者需要额外使用组织型纤溶酶原激活剂（tPA）治疗。并发症包括短暂性肾功能衰竭、1 例脾梗死和 1 例 tPA 后发生的脑血管意外。溶血的急性事件通过药物治疗得到解决，所有患者均成功出院。然而，复发性溶血很常见（6/8 例患者在接下来的 1-7 个月）。在随访结束时，3 例患者接受了移植，1 例患者因复发性溶血拒绝 LVAD 更换而死亡，4 例患者仍在 LVAD 支持下存活。强化抗凝治疗的药物治疗可以有效解决急性溶血事件。然而，由于复发率较高，应制定明确的长期策略。
