1 Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Germany.
2 Department of Cardiovascular Surgery, University Heart Center Hamburg Eppendorf, Germany.
Eur Heart J Acute Cardiovasc Care. 2018 Dec;7(8):766-770. doi: 10.1177/2048872616688418. Epub 2017 Jan 6.
: Pump thrombosis is a major complication of the continuous flow left ventricular assist device. Pump exchange is seen as the therapeutic gold standard. In this study, we report on our experience with using tissue-type plasminogen activator thrombolysis for therapy of pump thrombosis.
: We report on our experience with treatment of continuous flow left ventricular assist device pump thrombosis with the HVAD using tissue-type plasminogen activator thrombolysis in nine patients with 16 thrombotic events. In all events we used a uniform treatment protocol.
: All patients presented with a sufficient anticoagulation and had symptoms of heart failure. However, all patients were haemodynamically stable. Six of nine patients presented with a mean arterial pressure above 85 mm Hg and every patient presented with an infection. In all events we achieved short-term success with resolution of the pump thrombosis within a median time of nine hours. Three of nine patients developed recurrent pump thrombosis after >60 days. Besides one case of nonfatal intracranial haemorrhage and one case of minor bleeding, there were no adverse events.
: Our data indicates that using a uniform treatment protocol that builds on usage of tissue-type plasminogen activator thrombolysis might be an effective tool for treatment of continuous flow left ventricular assist device pump thrombosis in haemodynamically stable patients. Additionally, our data indicates that infection may be a potential trigger for pump thrombosis.
泵血栓形成是连续流动左心室辅助装置的主要并发症。泵更换被视为治疗的金标准。在这项研究中，我们报告了使用组织型纤溶酶原激活物溶栓治疗泵血栓形成的经验。
我们报告了使用组织型纤溶酶原激活物溶栓治疗 9 例 16 例血栓形成事件的连续流动左心室辅助装置泵血栓形成的经验。在所有事件中，我们使用了统一的治疗方案。
所有患者均有充分的抗凝治疗，且有心力衰竭症状。然而，所有患者血流动力学均稳定。9 例中有 6 例平均动脉压>85mmHg，每例患者均有感染。在所有事件中，我们在中位时间 9 小时内达到了短期成功，泵血栓形成得到了缓解。9 例中有 3 例在>60 天后发生复发性泵血栓形成。除了 1 例非致命性颅内出血和 1 例轻微出血外，无不良事件。
我们的数据表明，使用基于组织型纤溶酶原激活物溶栓的统一治疗方案可能是治疗血流动力学稳定患者连续流动左心室辅助装置泵血栓形成的有效工具。此外，我们的数据表明感染可能是泵血栓形成的潜在触发因素。
