title: Systemic Thrombolysis Versus Device Exchange for Pump Thrombosis Management: A Single-Center Experience.
abstract: In patients with left ventricular assist device (LVAD) implants, pump thrombosis is a potential life-threatening complication. In a retrospective data analysis, we compared clinical outcomes in 50 patients with HeartWare (HW) or HeartMate II implants undergoing device exchange (DEx; n = 21) or systemic thrombolysis (STL; n = 29) for pump thrombosis. Primary end-point was survival up to 90 days postintervention. Secondary end-points were the need for blood products postintervention, duration of intensive care unit stay, in-hospital stay, 90 day and 2 year therapy failure (the need for additional surgical or nonsurgical intervention because of pump thrombosis), and 2 year survival. Ninety-day survival was 89.3% in the STL group and 91.0% in the DEx group (p = 0.901). Compared with the DEx group, the average use of different blood products was lower (p < 0.001), and duration of intensive care unit stay and in-hospital stay tended to be shorter in the STL group (p values = 0.086 and 0.048, respectively). However, 90 day freedom from therapy failure was significantly lower in the STL group than in the DEx exchange group (p = 0.027) and so was 2 year freedom from therapy failure (p = 0.006). Two-year survival was comparable between groups (p = 0.267). Our data indicate that STL can be considered as a therapeutic option in LVAD patients with pump thrombosis.
authors.affiliation: From the *Clinic for Thoracic and Cardiovascular Surgery and †Institute of Anesthesiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Cenk
authors.initials: C
authors.lastname: Oezpeker
authors.forename: Armin
authors.initials: A
authors.lastname: Zittermann
authors.forename: Stephan
authors.initials: S
authors.lastname: Ensminger
authors.forename: Lukas
authors.initials: L
authors.lastname: Kizner
authors.forename: Andreas
authors.initials: A
authors.lastname: Koster
authors.forename: Ali
authors.initials: A
authors.lastname: Sayin
authors.forename: Michael
authors.initials: M
authors.lastname: Schoenbrodt
authors.forename: Hendrik
authors.initials: H
authors.lastname: Milting
authors.forename: Jan F
authors.initials: JF
authors.lastname: Gummert
authors.forename: Michiel
authors.initials: M
authors.lastname: Morshuis
mesh_terms: D020878:Device Removal; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000209:etiology* / Q000628:therapy*