Diagnosis and Treatment Algorithm for Blood Flow Obstructions in Patients With Left Ventricular Assist Device.
Thrombosis is an uncommon, but severe complication of left ventricular assist devices (LVADs).



This study analyzed experience with obstruction of blood flow through the LVAD with the purpose of developing optimal diagnosis and treatment of LVAD-related thrombosis.



Between October 2009 and July 2015, a total of 652 LVAD were implanted in 557 patients. Blood flow abnormalities in patients with LVAD (n = 524) were identified and classified as "high-power" and "low-flow" events.



Three types of late blood flow obstructions were identified: 1) pre-pump via thrombus obstructing the inflow cannula (26 events; 0.037 events per patient-year); 2) intra-pump (70 events; 0.1 events per patient-year); and 3) post-pump via thrombosis of the outflow graft or stenosis of the anastomosis to the aorta (4 events; 0.006 events per patient-year). Pre-pump obstruction was treated by washout maneuver in 9 cases (success rate, 100%), thrombolysis in 9 patients (success rate, 56%), and pump exchange in 9 cases (success rate, 100%); 1 patient died without treatment and 2 were weaned from LVAD. Intra-pump obstruction was treated by thrombolysis (n = 9; success rate, 33%), pump exchange (n = 53; success rate, 94%), and removal due to myocardial recovery (n = 3; success rate, 100%); 7 patients died without treatment and parameters spontaneously normalized in 2 cases. Post-pump obstruction was treated in 2 patients by stenting (success rate, 100%), and was left untreated in 2 cases.



We identified 3 types of LVAD-related blood flow obstruction, and developed an algorithm for optimal diagnosis and treatment.
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: mara.scandroglio@gmail.com.
Anna Mara
AM
Scandroglio
Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
Friedrich
F
Kaufmann
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Marina
M
Pieri
Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
Alexandra
A
Kretzschmar
Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
Marcus
M
Müller
Department of Internal Medicine - Cardiology, German Heart Center Berlin, Berlin, Germany.
Panagiotis
P
Pergantis
Department of Internal Medicine - Cardiology, German Heart Center Berlin, Berlin, Germany.
Stephan
S
Dreysse
Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Volkmar
V
Falk
Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
Thomas
T
Krabatsch
Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
Evgenij V
EV
Potapov
D000465:Algorithms; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017131:Thrombectomy / Q000295:instrumentation; D013927:Thrombosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D000077466:Tirofiban; D014443:Tyrosine / Q000031:analogs & derivatives / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D014443:Tyrosine; D000077466:Tirofiban
algorithm; complication; left ventricular assist device; mechanical circulatory support; thrombosis