Systemic or Endoventricular Thrombolysis to Treat HeartWare Left Ventricle Assist Device Thrombosis: A Clinical Dilemma

Artif Organs. 2015 Jun;39(6):526-9. doi: 10.1111/aor.12423. Epub 2015 Mar 4.

Abstract

Endoventricular thrombolytic procedure (ETP) has been used to treat continuous-flow left ventricle assist device (CF-LVAD) thrombosis. The study aims to investigate the occurrence of complications after ETP. Data were retrospectively reviewed and analyzed in a series of patients who underwent CF-LVAD followed by ETP. Since November 2010, 20 patients underwent HeartWare CF-LVAD implantation at our institute. Four patients (20%) developed pump thrombosis and underwent a total of nine ETPs with tissue plasminogen activator infused into the left ventricle. The mean age was 60.2 ± 9 years. ETP was performed via either the femoral (n = 6) or radial artery (n = 3). Five ETPs (55.5%) were complicated by left and right radial artery occlusion, two by groin hematomas, and one by femoral artery false aneurysm. ETP carries a strong risk of vascular access complications that, in CF-LVAD patients, may add to the already complex clinical profile and economic burden; thus, a less invasive treatment is advisable whenever required.

Keywords: Continuous-flow pump; Thrombolysis; Vascular access-site complications.

MeSH terms

  • Aged
  • Fibrinolytic Agents / therapeutic use*
  • Heart-Assist Devices / adverse effects*
  • Humans
  • Middle Aged
  • Retrospective Studies
  • Thrombolytic Therapy / methods*
  • Thrombosis / drug therapy*
  • Thrombosis / etiology
  • Tissue Plasminogen Activator / therapeutic use*
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator