Format

Send to

Choose Destination
Ann Thorac Surg. 2013 Oct;96(4):1259-1265. doi: 10.1016/j.athoracsur.2013.05.081. Epub 2013 Aug 20.

Surgical technique influences HeartMate II left ventricular assist device thrombosis.

Author information

1
Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
2
Yale University School of Medicine, New Haven, Connecticut.
3
Biostatistics Consulting Center, Temple University School of Medicine, Philadelphia, Pennsylvania.
4
Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut.
5
Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut. Electronic address: abeel.mangi@yale.edu.

Abstract

BACKGROUND:

Thrombosis of the HeartMate II (HM2 [Thoratec Corporation, Pleasanton, CA]) is a potentially devastating complication. While attention has been focused on anticoagulation strategies to prevent this complication, the impact of surgical technique has not been assessed.

METHODS:

Patients undergoing HM2 implantation at two institutions were reviewed. Pump thrombosis (PT) was defined as a clinical syndrome that included more than 30% elevation in pump power, more than 30% elevation in lactate dehydrogenase, and greater than 20% decrease in hemoglobin with the presence of thrombus in the HM2 stator or rotor, or both, at explant or autopsy. A blinded clinician reviewed dimensions and angles of the HM2 obtained from chest x-ray films. Patients demonstrating PT were compared with patients having normal function.

RESULTS:

Of the 49 patients reviewed, 11 (22.4%) displayed evidence of PT at a median of 42 days after HM2 implantation. Patient with PT had greater acute angulation of the HM2 inflow cannula immediately postoperatively (48.2 ± 6.8 versus 65.4 ± 9.2 degrees, p < 0.001) and after 30 days (50.1 ± 8.0 versus 65.1 ± 9.9 degrees, p < 0.001). Pump pocket depth was lower in the PT group immediately after HM2 implantation (107.0 ± 41.9 versus 144.3 ± 20.3 cm, p < 0.001) and after 30 days (86.0 ± 39.1 versus 113.1 ± 25.4 cm, p = 0.02). Patients with evidence of PT did not have a decrease in end-diastolic diameter (76 ± 9 versus 70 ± 15 mm, p = 0.24) whereas patients in the normal function group had effective remodeling of the left ventricle (70 ± 10 versus 56 ± 12 mm, p = 0.01).

CONCLUSIONS:

Meticulous surgical technique, which necessitates creating an adequately sized pump pocket and appropriately directing the inflow cannula at the time of operation, may reduce the risk of PT.

KEYWORDS:

27; CT; CXR; HM2; HeartMate II; IC; INR; INTERMACS; Interagency Registry for Mechanically Assisted Circulatory Support; LVAD; LVEDD; NF; OC; PP; PT; chest roentgenogram; computed tomography; inflow cannula; international normalized ratio; left ventricular assist device; left ventricular end-diastolic diameter; normal functioning; outflow cannula; pump pocket; pump thrombosis

Comment in

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center