Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Ann Thorac Surg. 2020 Dec;110(6):2047-2054. doi: 10.1016/j.athoracsur.2020.03.061. Epub 2020 Apr 26.
This study reports a single-center experience with thrombolytics for left ventricular assist device (LVAD) pump thrombosis.
Adults undergoing continuous-flow LVAD implantation between 2004 and 2018 at a single center were reviewed and those with pump thrombosis were identified. Primary outcomes included 1-year survival and success rates of thrombolytic therapy. Secondary outcomes included posttreatment adverse events, freedom from major bleeding at 1 year, and freedom from stroke at 1-year follow-up.
A total of 341 patients underwent LVAD implantation and 10.8% (n = 37) developed pump thrombosis. Of those 37, 26 received initial thrombolytic therapy (70.2%), 5 underwent direct pump exchange (13.5%), and 6 received only intravenous heparin owing to presentation with acute stroke or severe multiorgan failure (16.2%). Successful treatment was achieved in 11.5% of patients receiving thrombolytics (n = 3). Early adverse events after thrombolytic therapy included major bleeding in 11.5% (n = 3) and new stroke in 7.7% (n = 2). Most patients undergoing thrombolytic therapy underwent subsequent device exchange (69.2%; n = 18). Overall survival in patients with pump thrombosis after treatment was 96.8% at 30 days, 78.9% at 90 days, and 63.1% at 1 year. Freedom from major bleeding and stroke at 1 year was 74.2% and 87.2%, respectively.
In this single-center experience of thrombolytics for pump thrombosis in LVAD patients, there was limited efficacy; most patients required subsequent pump exchange. Combined with the risk for major bleeding or stroke with thrombolysis, this underscores the importance of further refining patient selection for direct pump exchange in those presenting with pump thrombosis.
本研究报告了一家中心使用溶栓药物治疗左心室辅助装置（LVAD）泵血栓形成的经验。
对 2004 年至 2018 年在一家中心接受连续血流 LVAD 植入术的成年人进行了回顾分析，并确定了发生泵血栓形成的患者。主要结局包括 1 年生存率和溶栓治疗成功率。次要结局包括治疗后不良事件、1 年时无大出血的发生率和 1 年随访时无卒中的发生率。
共有 341 例患者接受了 LVAD 植入术，其中 10.8%（n=37）发生了泵血栓形成。在这 37 例患者中，26 例接受了初始溶栓治疗（70.2%），5 例直接进行了泵置换（13.5%），6 例因出现急性卒中或严重多器官功能衰竭而仅接受了静脉肝素治疗（16.2%）。接受溶栓治疗的患者中，有 11.5%（n=3）治疗成功。溶栓治疗后的早期不良事件包括大出血 11.5%（n=3）和新发卒中 7.7%（n=2）。大多数接受溶栓治疗的患者随后进行了装置更换（69.2%；n=18）。治疗后泵血栓形成患者的 30 天、90 天和 1 年总生存率分别为 96.8%、78.9%和 63.1%。1 年时无大出血和卒中的发生率分别为 74.2%和 87.2%。
在本中心使用溶栓药物治疗 LVAD 患者泵血栓形成的经验中，疗效有限；大多数患者需要随后进行泵置换。结合溶栓治疗发生大出血或卒中的风险，这突显了在发生泵血栓形成时进一步完善直接泵置换患者选择的重要性。
