Köksel U, Erbasan O, Bayezid Ö, Kemaloğlu C, Özçobanoğlu S, Gölbaşı I, Türkay C
Department of Cardiovascular Surgery, Akdeniz University Hospital, Antalya, Turkey.
Department of Cardiovascular Surgery, Akdeniz University Hospital, Antalya, Turkey.
Transplant Proc. 2016 Jul-Aug;48(6):2162-7. doi: 10.1016/j.transproceed.2016.04.025.
Continuous-flow left ventricular assist devices (CF-LVADs) such as the HeartMate II and HeartWare left ventricular assist device are important alternatives to heart transplantation. Thrombosis is a serious complication in both devices and we present our approach to treating thrombosis and analysis of predisposition factors.
Our center's CF-LVADs database was retrospectively reviewed for pump thrombosis between January 2011 and January 2015. The patients were grouped for pump thrombosis (n = 13) and nonpump thrombosis (n = 85). Patients with pump thrombosis were further divided by device type (n = 5 HeartMate II and n = 8 HeartWare left ventricular assist device). Predisposition factors for pump thrombosis, our treatment approach, and patient outcomes were evaluated.
Pump thrombosis was diagnosed in 13 of 98 patients. The rate of pump thrombosis did not differ between the 37 HeartMate II and 61 HeartWare left ventricular assist device patients. High mean arterial blood pressure (P < .01) and noncompliance with the anticoagulation regimen (P = .04) were associated significantly with thrombosis. Twelve patients with stable hemodynamics were treated initially with intravenous tissue plasminogen activator and 1 patient who had end-organ damage underwent pump exchange. Two patients failed to respond to medical treatment and underwent pump exchange. Two patients with recurrent thrombosis were administered intracardiac tissue plasminogen activator. Five patients died after medical treatment and 4 deaths were due to cerebral hemorrhage.
Avoiding increased mean arterial blood pressures and ensuring optimal anticoagulation may help to decrease pump thrombosis. In patients with pump thrombosis, thrombolytic therapy is an alternative that is less invasive than pump exchange, but carries the risk of hemorrhage and thromboembolism.
持续血流左心室辅助装置（CF-LVADs），如HeartMate II和HeartWare左心室辅助装置，是心脏移植的重要替代方案。血栓形成是这两种装置的严重并发症，我们在此介绍我们治疗血栓形成的方法及易患因素分析。
回顾性分析2011年1月至2015年1月期间我们中心CF-LVADs数据库中有关泵血栓形成的情况。将患者分为泵血栓形成组（n = 13）和非泵血栓形成组（n = 85）。泵血栓形成患者再根据装置类型进一步分组（n = 5例HeartMate II和n = 8例HeartWare左心室辅助装置）。评估泵血栓形成的易患因素、我们的治疗方法及患者预后。
98例患者中有13例被诊断为泵血栓形成。37例使用HeartMate II和61例使用HeartWare左心室辅助装置的患者中，泵血栓形成发生率无差异。平均动脉血压高（P <.01）和不遵守抗凝方案（P =.04）与血栓形成显著相关。12例血流动力学稳定的患者最初接受静脉注射组织纤溶酶原激活剂治疗，1例出现终末器官损害的患者接受了泵更换。2例患者药物治疗无效，接受了泵更换。2例复发性血栓形成患者接受了心内组织纤溶酶原激活剂治疗。5例患者经药物治疗后死亡，4例死于脑出血。
避免平均动脉血压升高并确保最佳抗凝可能有助于减少泵血栓形成。对于泵血栓形成患者，溶栓治疗是一种比泵更换侵入性小的替代方法，但有出血和血栓栓塞风险。
