title: Hemolysis in left ventricular assist device: a retrospective analysis of outcomes.
abstract: BACKGROUND
  Hemolysis is becoming increasingly recognized as a major complication of left ventricular assist device (LVAD) support. Data regarding risk factors, prevalence, and outcomes are limited. To better define the characteristics and prognosis of hemolysis, we present a retrospective case-control study of LVAD patients in our institution.
  
  
  METHODS
  A detailed record review was conducted of 18 patients supported with the HeartMate II (HMII; Thoratec Corp, Pleasanton, CA) who were diagnosed with hemolysis, and their data were compared with 82 patients who received an LVAD implant during the same period who did not develop hemolysis. Patients were excluded if they did not survive hospitalization at the time of LVAD implantation. The primary end points of this analysis were time to death and time to first hospitalization.
  
  
  RESULTS
  Of 100 total patients, 18 HMII patients (18%) were diagnosed with hemolysis. Those with hemolysis were younger, had significantly higher lactate dehydrogenase and bilirubin levels, lower international normalized ratio, and no difference in cannula velocities by transthoracic echocardiography. Patient survival in the hemolysis group was markedly decreased at 1 year (38.9% vs 89.3%, p < 0.001), but no differences in hospitalization (p = 0.57) were observed. Partial to complete thrombosis was noted in all of the pumps at explant.
  
  
  CONCLUSIONS
  These findings demonstrate that hemolysis is associated with high mortality, likely serving as a marker of pump thrombosis. Elevated lactate dehydrogenase and bilirubin levels are important indicators for hemolysis, and lower international normalized ratio may pre-dispose for this worrisome condition. Diagnosis should prompt clinicians to consider pump exchange or explant, listing for transplantation, or intensifying anti-coagulation.
authors.affiliation: Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri. Electronic address: aravicha@dom.wustl.edu.
authors.forename: Ashwin K
authors.initials: AK
authors.lastname: Ravichandran
authors.affiliation: Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Parker
authors.affiliation: Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: Eric
authors.initials: E
authors.lastname: Novak
authors.affiliation: Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Joseph
authors.affiliation: Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Schilling
authors.affiliation: Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Ewald
authors.affiliation: Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: Scott
authors.initials: S
authors.lastname: Silvestry
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006461:Hemolysis / Q000502:physiology*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013927:Thrombosis / Q000453:epidemiology* / Q000401:mortality; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*
chemical_list: D015415:Biomarkers; D007770:L-Lactate Dehydrogenase; D001663:Bilirubin
keywords: bilirubin; hemolysis; international normalized ratio; lactase dehydrogenase; left ventricular assist device; thrombus