title: Successful treatment of acute left ventricular assist device thrombosis and cardiogenic shock with intraventricular thrombolysis and a tandem heart.
abstract: Management for continuous flow left ventricular assist device (LVAD) thrombosis often relies on speculation of individual clinical risk factors and integration of indirect evidence for device dysfunction. There are no comprehensive guidelines for treatment of this serious complication, and most of our current knowledge comes from anecdotal experience or observational study. More data on effective treatment, both with aggressive pharmacologic and device-based interventions, are needed for improving our understanding of mechanisms driving device thrombosis and for preventing future events. We present a case of LVAD thrombosis with emphasis on recognition and treatment of acute pump thrombosis, and discuss a potentially novel strategy using percutaneous mechanical circulatory support for pump salvage.
authors.affiliation: From the *Division of Cardiology, Department of Medicine, †Department of Cardiothoracic Surgery, Cardiovascular Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania.
authors.forename: Richa
authors.initials: R
authors.lastname: Agarwal
authors.forename: Amresh
authors.initials: A
authors.lastname: Raina
authors.forename: David M
authors.initials: DM
authors.lastname: Lasorda
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Moraca
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Bailey
authors.forename: Manreet
authors.initials: M
authors.lastname: Kanwar
authors.forename: George
authors.initials: G
authors.lastname: Sokos
authors.forename: Srinivas
authors.initials: S
authors.lastname: Murali
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Benza
mesh_terms: D000328:Adult; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D011475:Prosthesis Failure; D012770:Shock, Cardiogenic / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator