1
|
Gupta G, Yan CL, Kalwar T, Thakkar-Rivera N. Left ventricular assist device thrombosis in the setting of supratherapeutic international normalized ratio (INR) and bleeding. Blood Coagul Fibrinolysis 2023; 34:414-418. [PMID: 37577875 DOI: 10.1097/mbc.0000000000001241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
A 71-year-old female with heart failure who underwent left ventricular assist device (LVAD) placement presented for evaluation of low hemoglobin and dark stools. She also had leg pain, numbness, and weakness for which she was taking ibuprofen. She was found to have a gastrointestinal bleed, INR of 4.3, and arterial thrombi in the left leg. She was stabilized, had her anticoagulation held, and underwent mechanical thrombectomy. On hospital day 6, LVAD interrogation revealed signs of thrombosis, while subsequent labs revealed a persistently supratherapeutic INR of 5.2. The patient had the LVAD removed and underwent further hematologic workup. Her platelets remained normal throughout the admission, indicating this was not acute disseminated intravascular coagulation (DIC), thrombotic thrombocytopenic purpura (TTP), or heparin induced thrombocytopenia (HIT). Echocardiography identified it as a primary thrombus. This case illustrates the importance of appropriate anticoagulation to balance the bleeding risk with the risk of thrombi, as well as the importance of maintaining high suspicion for LVAD thrombosis regardless of INR.
Collapse
Affiliation(s)
| | - Crystal L Yan
- Divison of Internal Medicine, University of Miami/Jackson Memorial Hospital
| | - Tricia Kalwar
- Divison of Hematology, Broward Health Medical Center
| | - Nina Thakkar-Rivera
- Divison of Cardiology, University of Miami Health System, Miami Transplant Institute, Miami, Florida, USA
| |
Collapse
|
2
|
Biological Response to Sintered Titanium in Left Ventricular Assist Devices: Pseudoneointima, Neointima, and Pannus. ASAIO J 2023; 69:1-10. [PMID: 35649199 DOI: 10.1097/mat.0000000000001777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Titanium alloys have traditionally been used in blood-contacting cardiovascular devices, including left ventricular assist devices (LVADs). However, titanium surfaces are susceptible to adverse coagulation, leading to thrombogenesis and stroke. To improve hemocompatibility, LVAD manufacturers introduced powder sintering on blood-wetted surfaces in the 1980s to induce endothelialization. This technique has been employed in multiple contemporary LVADs on the pump housing, as well as the interior and exterior of the inflow cannula. Despite the wide adoption of sintered titanium, reported biologic response over the past several decades has been highly variable and apparently unpredictable-including combinations of neointima, pseudoneoimtima, thrombus, and pannus. We present a history of sintered titanium used in LVAD, a review of accumulated clinical outcomes, and a synopsis of gross appearance and composition of various depositions found clinically and in animal studies, which is unfortunately confounded by the variability and inconsistency in terminology. Therefore, this review endeavors to introduce a unified taxonomy to harmonize published observations of biologic response to sintered titanium in LVADs. From these data, we are able to deduce the natural history of the biologic response to sintered titanium, toward development of a deterministic model of the genesis of a hemocompatible neointima.
Collapse
|
3
|
Classification of the Frequency, Severity, and Propagation of Thrombi in the HeartMate II Left Ventricular Assist Device. ASAIO J 2020; 66:992-999. [DOI: 10.1097/mat.0000000000001151] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
|
4
|
Horobin JT, Simmonds MJ, Nandakumar D, Gregory SD, Tansley G, Pauls JP, Girnghuber A, Balletti N, Fraser JF. Speed Modulation of the HeartWare HVAD to Assess In Vitro Hemocompatibility of Pulsatile and Continuous Flow Regimes in a Rotary Blood Pump. Artif Organs 2018; 42:879-890. [PMID: 29726019 DOI: 10.1111/aor.13142] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/22/2018] [Accepted: 02/13/2018] [Indexed: 12/12/2022]
Abstract
Although rotary blood pumps (RBPs) sustain life, blood exposure to continuous supra-physiological shear stress induces adverse effects (e.g., thromboembolism); thus, pulsatile flow in RBPs represents a potential solution. The present study introduced pulsatile flow to the HeartWare HVAD using a custom-built controller and compared hemocompatibility biomarkers (i.e., platelet aggregation, concentrations for ADAMTS13, von Willebrand factor (vWf), and free-hemoglobin in plasma (pfHb), red blood cell (RBC) deformability, and RBC-nitric oxide synthase (NOS) activity) between continuous and pulsatile flow in a blood circulation loop over 5 h. The HeartWare HVAD was operated using a custom-built controller, at continuous speed (3282 rev/min) or in a pulsatile mode (mean speed = 3273 rev/min, amplitude = 430 rev/min, frequency = 1 Hz) to generate a blood flow rate of 5.0 L/min, HVAD differential pressure of 90 mm Hg for continuous flow and 92 mm Hg for pulsatile flow, and systolic and diastolic pressures of 121/80 mm Hg. For both flow regimes, the current study found; (i) ADP- and collagen-induced platelet aggregation, and ADAMTS13 concentration significantly decreased after 5 h (P < 0.01; P < 0.05), (ii) ristocetin-induced platelet aggregation significantly increased after 45 min (P < 0.05), (iii) vWf concentration did not significantly differ at any time point, (iv) pfHb significantly increased after 5 h (P < 0.01), (v) RBC deformability improved during the continuous flow regime (P < 0.05) but not during pulsatile flow, and (vi) RBC-NOS activity significantly increased during continuous flow (15 min), and pulsatile flow (5 h; P < 0.05). The current study demonstrated: (i) speed modulation does not improve hemocompatibility of the HeartWare HVAD based on no observable differences being detected for routine biomarkers, and (ii) the time-course for increased RBC-NOS activity observed during continuous flow may have improved RBC deformability.
Collapse
Affiliation(s)
- Jarod T Horobin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Biorheology Research Laboratory, Griffith University, Gold Coast, Australia
| | - Michael J Simmonds
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Biorheology Research Laboratory, Griffith University, Gold Coast, Australia
| | - Deepika Nandakumar
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,School of Engineering, Griffith University, Gold Coast, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Shaun D Gregory
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,School of Engineering, Griffith University, Gold Coast, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Geoff Tansley
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,School of Engineering, Griffith University, Gold Coast, Australia
| | - Jo P Pauls
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Angela Girnghuber
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Nicoletta Balletti
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - John F Fraser
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| |
Collapse
|
5
|
Pediatric ventricular assist device thrombosis. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
6
|
Inhibition of ADAMTS-13 by Doxycycline Reduces von Willebrand Factor Degradation During Supraphysiological Shear Stress. JACC-HEART FAILURE 2015; 3:860-9. [DOI: 10.1016/j.jchf.2015.06.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 06/08/2015] [Accepted: 06/12/2015] [Indexed: 11/19/2022]
|
7
|
Oliveira GH, Al-Kindi SG, ElAmm C, Qattan MY, Deo S, Medalion B, Benatti RD, Osman MN, Ginwalla M, Park SJ, Simon DI. Platelet inhibition with ticagrelor for left ventricular assist device thrombosis. Circ Heart Fail 2015; 8:649-51. [PMID: 25991808 DOI: 10.1161/circheartfailure.115.002096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Guilherme H Oliveira
- From the Department of Medicine (G.H.O., S.G.A., C.E., M.Y.Q., R.D.B., M.N.O., M.G., D.I.S.) and Department of Surgery (S.D., B.M., S.J.P.), Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
| | - Sadeer G Al-Kindi
- From the Department of Medicine (G.H.O., S.G.A., C.E., M.Y.Q., R.D.B., M.N.O., M.G., D.I.S.) and Department of Surgery (S.D., B.M., S.J.P.), Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Chantal ElAmm
- From the Department of Medicine (G.H.O., S.G.A., C.E., M.Y.Q., R.D.B., M.N.O., M.G., D.I.S.) and Department of Surgery (S.D., B.M., S.J.P.), Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Marwan Y Qattan
- From the Department of Medicine (G.H.O., S.G.A., C.E., M.Y.Q., R.D.B., M.N.O., M.G., D.I.S.) and Department of Surgery (S.D., B.M., S.J.P.), Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Salil Deo
- From the Department of Medicine (G.H.O., S.G.A., C.E., M.Y.Q., R.D.B., M.N.O., M.G., D.I.S.) and Department of Surgery (S.D., B.M., S.J.P.), Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Benjamin Medalion
- From the Department of Medicine (G.H.O., S.G.A., C.E., M.Y.Q., R.D.B., M.N.O., M.G., D.I.S.) and Department of Surgery (S.D., B.M., S.J.P.), Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Rodolfo D Benatti
- From the Department of Medicine (G.H.O., S.G.A., C.E., M.Y.Q., R.D.B., M.N.O., M.G., D.I.S.) and Department of Surgery (S.D., B.M., S.J.P.), Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Mohamed N Osman
- From the Department of Medicine (G.H.O., S.G.A., C.E., M.Y.Q., R.D.B., M.N.O., M.G., D.I.S.) and Department of Surgery (S.D., B.M., S.J.P.), Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Mahazarin Ginwalla
- From the Department of Medicine (G.H.O., S.G.A., C.E., M.Y.Q., R.D.B., M.N.O., M.G., D.I.S.) and Department of Surgery (S.D., B.M., S.J.P.), Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Soon J Park
- From the Department of Medicine (G.H.O., S.G.A., C.E., M.Y.Q., R.D.B., M.N.O., M.G., D.I.S.) and Department of Surgery (S.D., B.M., S.J.P.), Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Daniel I Simon
- From the Department of Medicine (G.H.O., S.G.A., C.E., M.Y.Q., R.D.B., M.N.O., M.G., D.I.S.) and Department of Surgery (S.D., B.M., S.J.P.), Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| |
Collapse
|
8
|
|
9
|
Bartoli CR, Ailawadi G, Kern JA. Diagnosis, Nonsurgical Management, and Prevention of LVAD Thrombosis. J Card Surg 2013; 29:83-94. [DOI: 10.1111/jocs.12238] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Carlo R. Bartoli
- Division of Cardiovascular Surgery; University of Pennsylvania Medical Center; Philadelphia Pennsylvania
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery; University of Virginia Health System; Charlottesville Virginia
| | - John A. Kern
- Division of Thoracic and Cardiovascular Surgery; University of Virginia Health System; Charlottesville Virginia
| |
Collapse
|
10
|
Preoperative Cardiac Risk Assessment for Noncardiac Surgery in Patients with Heart Failure. Curr Heart Fail Rep 2013; 10:147-56. [DOI: 10.1007/s11897-013-0136-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
11
|
Al-Quthami AH, Jumean M, Kociol R, Pham DT, Kiernan M, DeNofrio D, Kapur NK. Eptifibatide for the Treatment of HeartMate II Left Ventricular Assist Device Thrombosis. Circ Heart Fail 2012; 5:e68-70. [DOI: 10.1161/circheartfailure.112.966804] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Adeeb H. Al-Quthami
- From the CardioVascular Center, Division of Cardiology (A.H.A., M.J., R.K., D.T.P., M.K., D.D., N.K.K.), Tufts Medical Center, Boston, MA
| | - Marwan Jumean
- From the CardioVascular Center, Division of Cardiology (A.H.A., M.J., R.K., D.T.P., M.K., D.D., N.K.K.), Tufts Medical Center, Boston, MA
| | - Robb Kociol
- From the CardioVascular Center, Division of Cardiology (A.H.A., M.J., R.K., D.T.P., M.K., D.D., N.K.K.), Tufts Medical Center, Boston, MA
| | - Duc Thinh Pham
- From the CardioVascular Center, Division of Cardiology (A.H.A., M.J., R.K., D.T.P., M.K., D.D., N.K.K.), Tufts Medical Center, Boston, MA
| | - Michael Kiernan
- From the CardioVascular Center, Division of Cardiology (A.H.A., M.J., R.K., D.T.P., M.K., D.D., N.K.K.), Tufts Medical Center, Boston, MA
| | - David DeNofrio
- From the CardioVascular Center, Division of Cardiology (A.H.A., M.J., R.K., D.T.P., M.K., D.D., N.K.K.), Tufts Medical Center, Boston, MA
| | - Navin K. Kapur
- From the CardioVascular Center, Division of Cardiology (A.H.A., M.J., R.K., D.T.P., M.K., D.D., N.K.K.), Tufts Medical Center, Boston, MA
| |
Collapse
|