Late bleeding from right internal mammary artery after HeartMate left ventricular assist device implantation.
Postoperative bleeding is one of the major complications after implantation of left ventricular assist devices. We experienced 5 unusual cases, which had bleeding from the right internal mammary artery between 5 and 69 days after implantation of a HeartMate (Thoratec Corporation, Pleasanton, CA) device. It was evident that the outflow graft had eroded through the vessel. Sudden decreases in device flow, hypotension, bleeding from the driveline or chest tube sites, and a drop in hematocrit were the initial manifestations. Chest roentgenogram and transthoracic echocardiography were effective in identifying hemothorax and cardiac tamponade. Four out of 5 patients survived to heart transplantation and were discharged from the hospital. When identified and treated appropriately, this complication does not impair patient outcome.
Division of Cardiothoracic Surgery, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA.
Takushi
T
Kohmoto
Mehmet C
MC
Oz
Yoshifumi
Y
Naka
D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects; D002311:Cardiomyopathy, Dilated / Q000139:chemically induced / Q000209:etiology / Q000601:surgery; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006493:Heparin / Q000009:adverse effects; D006689:Hodgkin Disease / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008297:Male; D008323:Mammary Arteries / Q000293:injuries*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications; D009205:Myocarditis / Q000150:complications; D010027:Osteotomy; D010996:Pleural Effusion / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011832:Radiation Injuries / Q000209:etiology / Q000601:surgery; D013249:Sternum / Q000601:surgery; D013908:Thoracotomy; D013921:Thrombocytopenia / Q000139:chemically induced / Q000150:complications
D000925:Anticoagulants; D006493:Heparin; D001241:Aspirin