Left ventricular assist device implantation in patients with left ventricular thrombus.

Abstract

An intra-cavitary left ventricular (LV) thrombus is a relative contraindication to LV assist device (LVAD) implantation based on increased thromboembolic risks. Herein, we present our experience with LVAD patients with or without preoperative diagnosis of LV-thrombus. We retrospectively investigated 563 patients who received LVAD implantation between 2004 and 2018. Diagnosis of LV-thrombus was verified with computed tomography scan, magnetic resonance imaging, echocardiography, or intraoperative LV inspection. The primary endpoint was 30-day survival free of stroke and pump thrombosis. Overall, 72 patients (12.8%) had a diagnosis of LV-thrombus. They were younger (51 years; IQR:41-59), affected by severely reduced ejection fraction (15%; IQR:10-20), more often presenting with dilated cardiomyopathy (61.8%) and INTERMACS profile 1 (33.3%). Preoperative atrial fibrillation was frequent in patients without LV-thrombus (38.9%). Conventional sternotomy was the preferred approach in LV-thrombus patients (77.8%), based on more HMII implantations in these patients (41.7%). Survival free of strokes and pump thrombosis at 30 days was comparable (P = .5751) between patients with (83.3%) or without LV-thrombus (80.9%). LVAD implantation in patients with preoperative LV-thrombus is safe and feasible. When managed through correct diagnostic and intraoperative strategies including accurate inspection of the LV cavity, these patients show similar 30-day outcomes compared to patients without LV-thrombus.

• Authors: Günes Dogan, Silvia Mariani, Jasmin S Hanke, Ezin Deniz, Ali Merzah, Tong Li, Axel Haverich, Jan D Schmitto
• Journal: Artificial organs (Artif Organs) Vol. 45 Issue 9 Pg. 1006-1013 (Sep 2021) ISSN: 1525-1594 [Electronic] United States
• PMID: 33872409 (Publication Type: Journal Article)
• Copyright: © 2021 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.

Topics

• Adult
• Female
• Heart Ventricles (diagnostic imaging)
• Heart-Assist Devices
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Sternotomy
• Thrombosis (complications, diagnostic imaging)