Original articleAdult cardiacSurgical Technique Influences HeartMate II Left Ventricular Assist Device Thrombosis
Section snippets
Patients and Methods
After Institutional Review Board approval, adult patients undergoing HM2 implantation from August 2009 to May 2012 were retrospectively reviewed, spanning the period when the preclotted outflow graft was made commercially available. Laboratory data including lactate dehydrogenase, INR, and hemoglobin were collected prospectively.
We used anteroposterior chest roentgenogram (CXR) to assess for inflow cannula (IC) angulation and pump pocket (PP) depth because its clinically practical, measurements
Baseline Patient Characteristics
Seventy-three patients underwent HM2 implantation during the study period. Twenty-four were excluded from the analysis because either all four criteria for PT were not present, patients did not fulfill requirements for the use of CXRs, or validation of the radiographic set-up error and rotation by CT scans could not be performed. The remaining 49 patients made up the cohort in this analysis. Of the 24 excluded patients, 2 displayed evidence of PT.
These 49 patients underwent HM2 implantation by
Comment
Continuous flow LVADs are smaller, more durable, offer better survival, and have a favorable adverse event profile [13] when compared with pulsatile devices. However, PT continues to be a significant problem [14]. Pump thrombosis is likely influenced by many factors such as infection (local or remote), the need for noncardiac surgery, or when anticoagulation therapy needs to be held in the event of gastrointestinal bleeding, neurologic hemorrhage, or epistaxis [15]. Although anticoagulation
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2022, Journal of Thoracic and Cardiovascular SurgeryLimited Efficacy of Thrombolytics for Pump Thrombosis in Durable Left Ventricular Assist Devices
2020, Annals of Thoracic SurgeryHeartWare Ventricular Assist Device Cannula Position and Hemocompatibility-Related Adverse Events
2020, Annals of Thoracic SurgeryNovel Formula to Calculate Three-Dimensional Angle Between Inflow Cannula and Device Body of HeartMate II LVAD
2020, Annals of Thoracic SurgeryCitation Excerpt :As a result, the 3D angles at our institution were wide with deep pump pockets, in general. In fact, our mean calculated 3D angle (from formula) was 74.4° ± 14.2° and mean 2D projected angle (from CXR) was 65.2° ± 11.3°, which is much wider compared with those of other investigators who reported the relationship between acute device angle and device thrombosis—for example, Taghavi and coworkers5 with 2D angle (60.5° at final follow-up). Another possible reason of no statistical differences in the angle between those with and without adverse events may have resulted from under-powered statistics due to the small sample size.