Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
J Am Coll Cardiol. 2016 Jun 14;67(23):2758-2768. doi: 10.1016/j.jacc.2016.03.573.
Thrombosis is an uncommon, but severe complication of left ventricular assist devices (LVADs).
This study analyzed experience with obstruction of blood flow through the LVAD with the purpose of developing optimal diagnosis and treatment of LVAD-related thrombosis.
Between October 2009 and July 2015, a total of 652 LVAD were implanted in 557 patients. Blood flow abnormalities in patients with LVAD (n = 524) were identified and classified as "high-power" and "low-flow" events.
Three types of late blood flow obstructions were identified: 1) pre-pump via thrombus obstructing the inflow cannula (26 events; 0.037 events per patient-year); 2) intra-pump (70 events; 0.1 events per patient-year); and 3) post-pump via thrombosis of the outflow graft or stenosis of the anastomosis to the aorta (4 events; 0.006 events per patient-year). Pre-pump obstruction was treated by washout maneuver in 9 cases (success rate, 100%), thrombolysis in 9 patients (success rate, 56%), and pump exchange in 9 cases (success rate, 100%); 1 patient died without treatment and 2 were weaned from LVAD. Intra-pump obstruction was treated by thrombolysis (n = 9; success rate, 33%), pump exchange (n = 53; success rate, 94%), and removal due to myocardial recovery (n = 3; success rate, 100%); 7 patients died without treatment and parameters spontaneously normalized in 2 cases. Post-pump obstruction was treated in 2 patients by stenting (success rate, 100%), and was left untreated in 2 cases.
We identified 3 types of LVAD-related blood flow obstruction, and developed an algorithm for optimal diagnosis and treatment.
血栓形成是左心室辅助装置（LVAD）罕见但严重的并发症。
本研究分析了 LVAD 血流阻塞的经验，旨在为 LVAD 相关血栓形成的最佳诊断和治疗提供依据。
2009 年 10 月至 2015 年 7 月，557 例患者共植入 652 个 LVAD。通过对 524 例 LVAD 患者的血流异常进行识别和分类，分为“高功率”和“低流量”事件。
发现 3 种晚期血流阻塞类型：1）预泵，血栓阻塞流入导管（26 例；每患者年 0.037 例）；2）泵内（70 例；每患者年 0.1 例）；3）后泵，流出移植物血栓形成或吻合口主动脉狭窄（4 例；每患者年 0.006 例）。前泵阻塞通过冲洗操作治疗 9 例（成功率 100%），溶栓治疗 9 例（成功率 56%），泵更换 9 例（成功率 100%）；1 例未治疗死亡，2 例脱离 LVAD。泵内阻塞通过溶栓治疗（9 例；成功率 33%）、泵更换（53 例；成功率 94%）和心肌恢复去除（3 例；成功率 100%）治疗；7 例未治疗死亡，2 例参数自发正常化。后泵阻塞在 2 例患者中通过支架治疗（成功率 100%），2 例未治疗。
我们确定了 3 种 LVAD 相关血流阻塞类型，并制定了最佳诊断和治疗的算法。
