Thorac Cardiovasc Surg 2014; 62 - OP44
DOI: 10.1055/s-0034-1367121

Management of pump thrombosis: Device exchange versus thrombolysis

C.U. Özpeker 1, M. Schönbrodt 1, J. Börgermann 2, J. Gummert 1, M. Morshuis 1
  • 1HDZ NRW, Herz-und Thoraxchirurgie, Bad Oeynhausen, Germany
  • 2HDZ NRW, Bad Oeynhausen, Germany

Objectives: Pump thrombosis of especially LVAD’s is one of the most common reasons for device failure leading to hemolysis, reduced flow or even acute pump stop. Systemic thrombolysis (STl) and device exchange (DEx) are the only treatment options in acute pump thrombosis. The aim of this study was to compare these two therapeutic options in outcome and to develop a decision tree for management of pump thrombosis.

Methods: Since the year 2006, 24 LVAD (gender: male n = 18;female 6) DEx were necessary due to pumpthrombosis. (n = 25,in one pt. 2 exchange were necessary). STl with Tecneplase or Alteplase were performed with 17 sequences in twelve pts (gender male n = 8; female n = 4, in one female patient four sequences) (see Table 1). All DEx procedures and STl treatments were retrospectively analyzed.

Device exchange vs. Systemic thrombolysis
LVAD-Device Thrombolysis seq/pt Succesrate pos/neg Exchange after lysis Exchange seq/pt Exchange (mort. < 48 hrs)
HMII 5/4 2/3 2 15/14 2
HVAD 12/8 11/1 1 5 (2 RVAD) 0
HeartAssist 0 0 0 2 1
Coraid 0 0 0 1 0

Results: In the DEx cohort three pts. expired within 48 hrs after the operation. 18 pts. could be discharged from the hospital after exchange. Six pts. expired after pump exchange due to poor preoperative status. The mean duration for MCS support was 466.8 before exchange. The post-operative hospital stay was mean 24 days. Redo thoracotomy because of bleeding was necessary in 4 pts. In the thrombolysis cohort 8 pts. survived without major bleeding complica-tions. In 3 pts. DEx was necessary after systemic lysis.

Conclusion: HTx is still the gold standard in device failure. If this is not possible due to donor organ shortage, a DEx or STl should be performed. STl is as-sociated with a minimum risk of complications, but strongly depends on the device and right timing of the treatment. STl seems to be a good option in HVAD pts, if there is no contraindication, this should be the first line therapy. In the HMII patient, STl is less efficient, DEx may be a better option. Different characteristics of thrombus formation and a different thrombus structure could be an explanation of the difference in successrate of STl in both devices.