Tarzia Vincenzo, Buratto Edward, Bortolussi Giacomo, Gallo Michele, Bejko Jonida, Bianco Roberto, Bottio Tomaso, Gerosa Gino
1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Melbourne, Australia.
Ann Cardiothorac Surg. 2014 Nov;3(6):582-4. doi: 10.3978/j.issn.2225-319X.2014.08.21.
Much of the morbidity and mortality associated with ventricular assist devices (VADs) is due to haemorrhagic and thrombotic complications. To manage antithrombotic therapy, interactions between the patient and pump should be better understood.
We have compared the Jarvik 2000, an axial flow left ventricular assist device (LVAD), with the HeartWare ventricular assist device (HVAD) centrifugal pump, regarding conventional laboratory findings, thromboelastometric and aggregometric tests.
Patients with the Jarvik 2000 experienced a significant reduction in platelet count following implantation, a phenomenon not seen with the HeartWare model. Conversely, we observed that levels of platelet activation, as assessed by a platelet function analyzer, and activation of the coagulation system, as assessed by thromboelastometry, were significantly greater in the HeartWare group.
It seems that axial flow pumps, being more destructive on blood cells, tend to reduce platelet numbers. On the other hand, centrifugal flow is associated with a hypercoagulable state, possibly resulting from the activation of the coagulation system in the absence of platelet destruction.
与心室辅助装置（VAD）相关的许多发病率和死亡率归因于出血和血栓形成并发症。为了管理抗血栓治疗，患者与泵之间的相互作用应得到更好的理解。
我们比较了轴流左心室辅助装置（LVAD）Jarvik 2000与HeartWare心室辅助装置（HVAD）离心泵在常规实验室检查结果、血栓弹性测定和凝集测定方面的差异。
植入Jarvik 2000的患者植入后血小板计数显著降低，而HeartWare模型未出现这种现象。相反，我们观察到，通过血小板功能分析仪评估的血小板活化水平以及通过血栓弹性测定评估的凝血系统活化水平在HeartWare组中显著更高。
似乎轴流泵对血细胞的破坏更大，倾向于减少血小板数量。另一方面，离心流与高凝状态相关，这可能是由于在无血小板破坏的情况下凝血系统被激活所致。
