Department of Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
J Card Surg. 2022 Oct;37(10):3440-3442. doi: 10.1111/jocs.16813. Epub 2022 Jul 27.
The success of the left ventricular assist device (LVAD) as a treatment for terminal left-side heart failure is still restrained by some severe complications associated with mechanical circulatory support. Pump thrombus still affects many patients. It is associated with high morbidity and mortality. The therapeutic options include augmentation of anticoagulation and antiplatelet medication, intravenous or catheter-guided thrombolysis, and pump exchange. Heart transplantation would be a desirable option in this population, but unfortunately, it is only theoretical given the increasing number of LVAD implants and decreasing number of organ donors. A retrograde washout maneuver may be a treatment option in prepump thrombosis in selected patients. Therefore, the decision should be made on an individual basis after balancing the risks and benefits of different treatment approaches. In this context, we report a case of retrograde washout of prepump thrombus in a patient who has been on HeartWare™ support for more than 3 years, with a successful bailout strategy.
左心室辅助装置 (LVAD) 在治疗终末期左侧心力衰竭方面取得了成功，但仍受到一些与机械循环支持相关的严重并发症的限制。泵血栓仍然影响着许多患者，其与高发病率和死亡率相关。治疗选择包括增加抗凝和抗血小板药物、静脉内或导管引导的溶栓以及泵更换。心脏移植对于这部分患者来说是一种理想的选择，但不幸的是，由于 LVAD 植入数量的增加和器官捐献数量的减少，这只是理论上的选择。在选择的患者中，逆行冲洗操作可能是预泵血栓的治疗选择。因此，应在权衡不同治疗方法的风险和益处后，根据个体情况做出决定。在这种情况下，我们报告了一例在 HeartWare™ 支持下超过 3 年的患者中进行逆行冲洗预泵血栓的病例，该患者采用了成功的抢救策略。
