Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Artif Organs. 2021 Sep;45(9):1006-1013. doi: 10.1111/aor.13963. Epub 2021 May 25.
An intra-cavitary left ventricular (LV) thrombus is a relative contraindication to LV assist device (LVAD) implantation based on increased thromboembolic risks. Herein, we present our experience with LVAD patients with or without preoperative diagnosis of LV-thrombus. We retrospectively investigated 563 patients who received LVAD implantation between 2004 and 2018. Diagnosis of LV-thrombus was verified with computed tomography scan, magnetic resonance imaging, echocardiography, or intraoperative LV inspection. The primary endpoint was 30-day survival free of stroke and pump thrombosis. Overall, 72 patients (12.8%) had a diagnosis of LV-thrombus. They were younger (51 years; IQR:41-59), affected by severely reduced ejection fraction (15%; IQR:10-20), more often presenting with dilated cardiomyopathy (61.8%) and INTERMACS profile 1 (33.3%). Preoperative atrial fibrillation was frequent in patients without LV-thrombus (38.9%). Conventional sternotomy was the preferred approach in LV-thrombus patients (77.8%), based on more HMII implantations in these patients (41.7%). Survival free of strokes and pump thrombosis at 30 days was comparable (P = .5751) between patients with (83.3%) or without LV-thrombus (80.9%). LVAD implantation in patients with preoperative LV-thrombus is safe and feasible. When managed through correct diagnostic and intraoperative strategies including accurate inspection of the LV cavity, these patients show similar 30-day outcomes compared to patients without LV-thrombus.
心室内左心室（LV）血栓是左心室辅助装置（LVAD）植入的相对禁忌证，因为血栓栓塞风险增加。在此，我们报告了我们在 LVAD 患者中术前诊断有或无 LV 血栓的经验。我们回顾性研究了 2004 年至 2018 年间接受 LVAD 植入的 563 例患者。LV 血栓的诊断通过计算机断层扫描、磁共振成像、超声心动图或术中 LV 检查得到证实。主要终点是 30 天无卒中及泵血栓生存。总体而言，72 例患者（12.8%）被诊断为 LV 血栓。这些患者更年轻（51 岁；IQR：41-59），射血分数严重降低（15%；IQR：10-20），更常患有扩张型心肌病（61.8%）和 INTERMACS 评分 1 级（33.3%）。无 LV 血栓患者中术前心房颤动更为常见（38.9%）。LV 血栓患者首选传统胸骨切开术（77.8%），因为这些患者中 HMII 植入更为常见（41.7%）。30 天无卒中及泵血栓生存的患者在有（83.3%）或无 LV 血栓（80.9%）的患者之间无差异（P=0.5751）。术前 LV 血栓患者的 LVAD 植入是安全可行的。通过正确的诊断和术中策略进行管理，包括准确检查 LV 腔，这些患者与无 LV 血栓患者相比，30 天结局相似。
