Stulak John M, Sharma Shashank, Maltais Simon
Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA,
Am J Cardiovasc Drugs. 2015 Apr;15(2):89-94. doi: 10.1007/s40256-014-0102-3.
The gradual evolution of left ventricular assist device (LVAD) therapy has resulted in a durable option for patients as either a bridge to transplantation (BTT) or a destination therapy (DT). Outcomes with current continuous-flow devices continue to demonstrate significant patient benefit, not only in enhanced survival but also in improved functional capacity and quality of life. While the lessening of adverse events through time has resulted in more widespread adoption of this therapy, there continues to be unintended consequences, including, most notably, infection, bleeding, and thrombosis. Beginning in 2011, centers and collaborative groups began to observe a significant increase in the incidence of pump thrombosis with the HeartMate II LVAD (Thoratec Corp., Pleasanton, CA, USA). However, this clinical scourge is not limited to the HeartMate II, as the HeartWare Ventricular Assist System (HVAD; HeartWare Inc., Framingham, MA, USA) has also had these same issues, which led to pump modifications and the appreciation of more strict control of blood pressure and anticoagulation with this pump design. We review the current status of the field of mechanical circulatory support in its approach to diagnosis, management, and prevention of LVAD pump thrombosis.
左心室辅助装置（LVAD）治疗的逐步发展为患者提供了一种持久的选择，可作为移植桥接治疗（BTT）或终末期治疗（DT）。目前的连续血流装置治疗结果持续显示出对患者有显著益处，不仅提高了生存率，还改善了功能能力和生活质量。虽然随着时间推移不良事件减少导致该治疗方法得到更广泛应用，但仍存在一些意外后果，最显著的包括感染、出血和血栓形成。从2011年开始，各中心和协作组开始观察到使用HeartMate II左心室辅助装置（美国加利福尼亚州普莱森顿市Thoratec公司）时泵血栓形成的发生率显著增加。然而，这种临床难题并不局限于HeartMate II，HeartWare心室辅助系统（HVAD；美国马萨诸塞州弗雷明汉市HeartWare公司）也存在同样问题，这导致了泵的改进，并认识到对于这种泵设计需要更严格地控制血压和抗凝。我们综述了机械循环支持领域在左心室辅助装置泵血栓形成的诊断、管理和预防方面的现状。
