title: Conservative approaches for HeartWare ventricular assist device pump thrombosis may improve the outcome compared with immediate surgical approaches.
abstract: Left ventricular assist device (LVAD) pump thrombosis is one of the devastating complications following mechanical circulatory support implantation. Surgical pump exchange is a known high-risk surgery with a high perioperative mortality rate. We aim to summarize our experience with several other alternative approaches in patients with suspected HeartWare HVAD (HeartWare, Framingham, MA, USA) pump thrombosis.
  
  
  
  The outcome of HeartWare HVAD implantations performed at single institution from January 2010 to September 2015 was studied. Inclusion criteria were patients with suspected HeartWare HVAD pump thrombosis. Patients' preoperative characteristics and outcome following various interventions were reviewed.
  
  
  
  A total of 94 HeartWare HVAD pumps were implanted in 91 patients. The inclusion criteria were met by 13 patients (14%) with a mean age of 55 ± 14 years old and a median total pump support duration of 467 days (11-937 days). A conservative approach using systemic thrombolysis (recombinant tissue plasminogen activator) + heparin was used in the majority of the patients (15 events = 65%). Heart transplantation was performed in 4 patients and device explantation in 2 patients. Other approaches were used in the rest of patients. Considering thrombolysis-related complications, 1 patient required resternotomy for bleeding after thrombolysis, which was necessary a few days after LVAD implant surgery and 2 patients developed minor intracranial bleeding after thrombolysis. One-year survival after the latest intervention was 69%.
  
  
  
  This report showed the feasibility of several alternative conservative approaches combining medications, minimally invasive and interventional methods for patients with HeartWare pump thrombosis. The outcome may be better than immediate surgical pump exchange.
authors.affiliation: Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany diyar.saeed@med.uni-duesseldorf.de.
authors.forename: Diyar
authors.initials: D
authors.lastname: Saeed
authors.affiliation: Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Bujar
authors.initials: B
authors.lastname: Maxhera
authors.affiliation: Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Albert
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Westenfeld
authors.affiliation: Institute for Hemostaseology, Haemotherapy and Transfusion Medicine, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Hoffmann
authors.affiliation: Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Artur
authors.initials: A
authors.lastname: Lichtenberg
mesh_terms: D000328:Adult; D000368:Aged; D020878:Device Removal; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000209:etiology* / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator
keywords: Cardiomyopathy; Complications; Heart failure; Heart-assist device; Pump thrombosis; Surgery