Haemolysis as a first sign of thromboembolic event and acute pump thrombosis in patients with the continuous-flow left ventricular assist device HeartMate II

Background

Despite advances in pump technology, thromboembolic events/acute pump thrombosis remain potentially life-threatening complications in patients with continuous-flow left ventricular assist devices (CF-LVAD). We sought to determine early signs of thromboembolic event/pump thrombosis in patients with CF-LVAD, which could lead to earlier intervention.

Methods

We analysed all HeartMate II recipients (n?=?40) in our centre between December 2006 and July 2013. Thromboembolic event/pump thrombosis was defined as a transient ischaemic attack (TIA), ischaemic cerebrovascular accident (CVA), or pump thrombosis.

Results

During median LVAD support of 336 days IQR: 182–808], 8 (20?%) patients developed a thromboembolic event/pump thrombosis (six TIA/CVA, two pump thromboses). At the time of the thromboembolic event/pump thrombosis, significantly higher pump power was seen compared with the no-thrombosis group (8.2?±?3.0 vs. 6.4?±?1.4 W, p?=?0.02), as well as a trend towards a lower pulse index (4.1?±?1.5 vs. 5.0?±?1.0, p?=?0.05) and a trend towards higher pump flow (5.7?±?1.0 vs. 4.9?±?1.9 L m, p?=?0.06).The thrombosis group had a more than fourfold higher lactate dehydrogenase (LDH) median 1548 IQR: 754–2379] vs. 363 IQR: 325–443] U/L, p?=?0.0001). Bacterial (n?=?4) or viral (n?=?1) infection was present in 5 out of 8 patients. LDH >?735 U/L predicted thromboembolic events/pump thrombosis with a positive predictive value of 88?%.

Conclusions

In patients with a CF-LVAD (HeartMate II), thromboembolic events and/or pump thrombosis are associated with symptoms and signs of acute haemolysis as manifested by a high LDH, elevated pump power and decreased pulse index, especially in the context of an infection.