Device thrombosis in HeartMate II continuous-flow left ventricular assist devices: A multifactorial phenomenon

Nir Uriel, Jason Han, Kerry A. Morrison, Nadav Nahumi, Melana Yuzefpolskaya, Arthur R. Garan, Jimmy Duong, Paolo C. Colombo, Hiroo Takayama, Sunu Thomas, Yoshifumi Naka, Ulrich P. Jorde

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Background Continuous-flow left ventricular assist devices (CF-LVADs) are increasingly used to support patients with advanced heart failure (HF). Device thrombosis is a serious complication of CF-LVADs, but its precise prevalence and etiology remains uncertain. Methods Root-cause analysis was performed in all cases with device thrombosis confirmed upon explant among patients implanted with a HeartMate II (HM II) from January 1, 2009 to November 15, 2012. Cannula position and bend relief integrity were assessed and charts were reviewed with particular attention to anti-coagulation and infection profiles. Results Nineteen of 177 patients (11%) were found to have device thrombosis of various etiologies after a mean of 351 ± 311 days, representing 0.12 event/patient-year. Of the 5 mechanically induced thromboses, proximate etiology was severely abnormal inflow cannula position in 3 patients and bend relief disconnect with deformed outflow graft in 2 patients. One patient had a hypercoagulable disorder with prior arterial embolism. In the remaining 13 patients (age 61 ± 14 years, 77% male, 69% Caucasian), "non-mechanical" device thrombosis occurred after 357 ± 383 days; INR at the time of diagnosis was 1.81 (1.62 to 2.07); and mean device speed was 8,855 ± 359 rpm. Five of 13 patients (38%) had an infection during the month leading up to device thrombosis. Of note, lactate dehydrogenase (LDH) was already elevated at the time of discharge in patients who would later develop non-mechanical device thrombosis (423 [354 to 766] vs 352 [272 to 373] U/liter, p < 0.01). Conclusions Device thrombosis is a multifactorial phenomenon, and differentiation of mechanical and non-mechanical causes is an essential step for individual diagnosis and treatment plans. Larger studies excluding patients with obvious mechanical etiology are needed to investigate biologic and/or management-related risk factors for device thrombosis. Our findings suggest that LDH may be an early risk marker. Due to the difficulty in treating late-stage device thrombosis, we suggest early use of simple tests to rule out both causes of thrombosis, such as X-rays and closer LDH monitoring (bi-weekly).

Original languageEnglish (US)
Pages (from-to)51-59
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume33
Issue number1
DOIs
StatePublished - Jan 2014
Externally publishedYes

Fingerprint

Heart-Assist Devices
Thrombosis
Equipment and Supplies
L-Lactate Dehydrogenase
Mechanical Phenomena
Root Cause Analysis
International Normalized Ratio
Patient Discharge
Infection
Embolism
Heart Failure
X-Rays
Transplants

Keywords

  • Advanced heart failure
  • Coagulation
  • Device thrombosis
  • International normalized ratio
  • Lactate dehydrogenase
  • Left ventricular assist device

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Device thrombosis in HeartMate II continuous-flow left ventricular assist devices : A multifactorial phenomenon. / Uriel, Nir; Han, Jason; Morrison, Kerry A.; Nahumi, Nadav; Yuzefpolskaya, Melana; Garan, Arthur R.; Duong, Jimmy; Colombo, Paolo C.; Takayama, Hiroo; Thomas, Sunu; Naka, Yoshifumi; Jorde, Ulrich P.

In: Journal of Heart and Lung Transplantation, Vol. 33, No. 1, 01.2014, p. 51-59.

Research output: Contribution to journalArticle

Uriel, N, Han, J, Morrison, KA, Nahumi, N, Yuzefpolskaya, M, Garan, AR, Duong, J, Colombo, PC, Takayama, H, Thomas, S, Naka, Y & Jorde, UP 2014, 'Device thrombosis in HeartMate II continuous-flow left ventricular assist devices: A multifactorial phenomenon', Journal of Heart and Lung Transplantation, vol. 33, no. 1, pp. 51-59. https://doi.org/10.1016/j.healun.2013.10.005
Uriel, Nir ; Han, Jason ; Morrison, Kerry A. ; Nahumi, Nadav ; Yuzefpolskaya, Melana ; Garan, Arthur R. ; Duong, Jimmy ; Colombo, Paolo C. ; Takayama, Hiroo ; Thomas, Sunu ; Naka, Yoshifumi ; Jorde, Ulrich P. / Device thrombosis in HeartMate II continuous-flow left ventricular assist devices : A multifactorial phenomenon. In: Journal of Heart and Lung Transplantation. 2014 ; Vol. 33, No. 1. pp. 51-59.
@article{ef5e1d4ae9d84915ae0bc6c1cdcb0cfe,
title = "Device thrombosis in HeartMate II continuous-flow left ventricular assist devices: A multifactorial phenomenon",
abstract = "Background Continuous-flow left ventricular assist devices (CF-LVADs) are increasingly used to support patients with advanced heart failure (HF). Device thrombosis is a serious complication of CF-LVADs, but its precise prevalence and etiology remains uncertain. Methods Root-cause analysis was performed in all cases with device thrombosis confirmed upon explant among patients implanted with a HeartMate II (HM II) from January 1, 2009 to November 15, 2012. Cannula position and bend relief integrity were assessed and charts were reviewed with particular attention to anti-coagulation and infection profiles. Results Nineteen of 177 patients (11{\%}) were found to have device thrombosis of various etiologies after a mean of 351 ± 311 days, representing 0.12 event/patient-year. Of the 5 mechanically induced thromboses, proximate etiology was severely abnormal inflow cannula position in 3 patients and bend relief disconnect with deformed outflow graft in 2 patients. One patient had a hypercoagulable disorder with prior arterial embolism. In the remaining 13 patients (age 61 ± 14 years, 77{\%} male, 69{\%} Caucasian), {"}non-mechanical{"} device thrombosis occurred after 357 ± 383 days; INR at the time of diagnosis was 1.81 (1.62 to 2.07); and mean device speed was 8,855 ± 359 rpm. Five of 13 patients (38{\%}) had an infection during the month leading up to device thrombosis. Of note, lactate dehydrogenase (LDH) was already elevated at the time of discharge in patients who would later develop non-mechanical device thrombosis (423 [354 to 766] vs 352 [272 to 373] U/liter, p < 0.01). Conclusions Device thrombosis is a multifactorial phenomenon, and differentiation of mechanical and non-mechanical causes is an essential step for individual diagnosis and treatment plans. Larger studies excluding patients with obvious mechanical etiology are needed to investigate biologic and/or management-related risk factors for device thrombosis. Our findings suggest that LDH may be an early risk marker. Due to the difficulty in treating late-stage device thrombosis, we suggest early use of simple tests to rule out both causes of thrombosis, such as X-rays and closer LDH monitoring (bi-weekly).",
keywords = "Advanced heart failure, Coagulation, Device thrombosis, International normalized ratio, Lactate dehydrogenase, Left ventricular assist device",
author = "Nir Uriel and Jason Han and Morrison, {Kerry A.} and Nadav Nahumi and Melana Yuzefpolskaya and Garan, {Arthur R.} and Jimmy Duong and Colombo, {Paolo C.} and Hiroo Takayama and Sunu Thomas and Yoshifumi Naka and Jorde, {Ulrich P.}",
year = "2014",
month = "1",
doi = "10.1016/j.healun.2013.10.005",
language = "English (US)",
volume = "33",
pages = "51--59",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "1",

}

TY - JOUR

T1 - Device thrombosis in HeartMate II continuous-flow left ventricular assist devices

T2 - A multifactorial phenomenon

AU - Uriel, Nir

AU - Han, Jason

AU - Morrison, Kerry A.

AU - Nahumi, Nadav

AU - Yuzefpolskaya, Melana

AU - Garan, Arthur R.

AU - Duong, Jimmy

AU - Colombo, Paolo C.

AU - Takayama, Hiroo

AU - Thomas, Sunu

AU - Naka, Yoshifumi

AU - Jorde, Ulrich P.

PY - 2014/1

Y1 - 2014/1

N2 - Background Continuous-flow left ventricular assist devices (CF-LVADs) are increasingly used to support patients with advanced heart failure (HF). Device thrombosis is a serious complication of CF-LVADs, but its precise prevalence and etiology remains uncertain. Methods Root-cause analysis was performed in all cases with device thrombosis confirmed upon explant among patients implanted with a HeartMate II (HM II) from January 1, 2009 to November 15, 2012. Cannula position and bend relief integrity were assessed and charts were reviewed with particular attention to anti-coagulation and infection profiles. Results Nineteen of 177 patients (11%) were found to have device thrombosis of various etiologies after a mean of 351 ± 311 days, representing 0.12 event/patient-year. Of the 5 mechanically induced thromboses, proximate etiology was severely abnormal inflow cannula position in 3 patients and bend relief disconnect with deformed outflow graft in 2 patients. One patient had a hypercoagulable disorder with prior arterial embolism. In the remaining 13 patients (age 61 ± 14 years, 77% male, 69% Caucasian), "non-mechanical" device thrombosis occurred after 357 ± 383 days; INR at the time of diagnosis was 1.81 (1.62 to 2.07); and mean device speed was 8,855 ± 359 rpm. Five of 13 patients (38%) had an infection during the month leading up to device thrombosis. Of note, lactate dehydrogenase (LDH) was already elevated at the time of discharge in patients who would later develop non-mechanical device thrombosis (423 [354 to 766] vs 352 [272 to 373] U/liter, p < 0.01). Conclusions Device thrombosis is a multifactorial phenomenon, and differentiation of mechanical and non-mechanical causes is an essential step for individual diagnosis and treatment plans. Larger studies excluding patients with obvious mechanical etiology are needed to investigate biologic and/or management-related risk factors for device thrombosis. Our findings suggest that LDH may be an early risk marker. Due to the difficulty in treating late-stage device thrombosis, we suggest early use of simple tests to rule out both causes of thrombosis, such as X-rays and closer LDH monitoring (bi-weekly).

AB - Background Continuous-flow left ventricular assist devices (CF-LVADs) are increasingly used to support patients with advanced heart failure (HF). Device thrombosis is a serious complication of CF-LVADs, but its precise prevalence and etiology remains uncertain. Methods Root-cause analysis was performed in all cases with device thrombosis confirmed upon explant among patients implanted with a HeartMate II (HM II) from January 1, 2009 to November 15, 2012. Cannula position and bend relief integrity were assessed and charts were reviewed with particular attention to anti-coagulation and infection profiles. Results Nineteen of 177 patients (11%) were found to have device thrombosis of various etiologies after a mean of 351 ± 311 days, representing 0.12 event/patient-year. Of the 5 mechanically induced thromboses, proximate etiology was severely abnormal inflow cannula position in 3 patients and bend relief disconnect with deformed outflow graft in 2 patients. One patient had a hypercoagulable disorder with prior arterial embolism. In the remaining 13 patients (age 61 ± 14 years, 77% male, 69% Caucasian), "non-mechanical" device thrombosis occurred after 357 ± 383 days; INR at the time of diagnosis was 1.81 (1.62 to 2.07); and mean device speed was 8,855 ± 359 rpm. Five of 13 patients (38%) had an infection during the month leading up to device thrombosis. Of note, lactate dehydrogenase (LDH) was already elevated at the time of discharge in patients who would later develop non-mechanical device thrombosis (423 [354 to 766] vs 352 [272 to 373] U/liter, p < 0.01). Conclusions Device thrombosis is a multifactorial phenomenon, and differentiation of mechanical and non-mechanical causes is an essential step for individual diagnosis and treatment plans. Larger studies excluding patients with obvious mechanical etiology are needed to investigate biologic and/or management-related risk factors for device thrombosis. Our findings suggest that LDH may be an early risk marker. Due to the difficulty in treating late-stage device thrombosis, we suggest early use of simple tests to rule out both causes of thrombosis, such as X-rays and closer LDH monitoring (bi-weekly).

KW - Advanced heart failure

KW - Coagulation

KW - Device thrombosis

KW - International normalized ratio

KW - Lactate dehydrogenase

KW - Left ventricular assist device

UR - http://www.scopus.com/inward/record.url?scp=84892157543&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892157543&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2013.10.005

DO - 10.1016/j.healun.2013.10.005

M3 - Article

C2 - 24290832

AN - SCOPUS:84892157543

VL - 33

SP - 51

EP - 59

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 1

ER -