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Surgical device exchange provides improved clinical outcomes compared to medical therapy in treating continuous-flow left ventricular assist device thrombosis.

MedStar author(s):

0160-564X

Name of journal: Artificial organsAbstract: The purpose of this study is to compare clinical outcomes of left ventricular assist device (LVAD) patients with device thrombosis who underwent device exchange or medical therapy alone. Consecutive patients undergoing LVAD implant between 7.2008 and 12.2017 were included. Device thrombosis was diagnosed with comprehensive assessments including ramp test, laboratory data, device parameters, and clinical presentations. Firstly, medical therapy was initiated in all patients. After medical therapy, device exchange was considered if device thrombosis was refractory to initial medical therapy, and it caused end-organ impairment and/or hemodynamic instability. Among 319 consecutive LVAD patients, 43 patients (13.5%) were diagnosed with device thrombosis. Device exchange was performed in 28 patients (DE group), device explant in 1 patient. Medical therapy was continued in 14 patients (MT group). In-hospital mortality was significantly lower in the DE group than the MT group (3.6% (1/28) vs. 28.6% (4/14), p=0.0184). One-year survival was significantly better in the DE group (74.0% vs. 30.1%; log-rank=0.001), and freedom from cerebrovascular accident at 1 year was greater in the DE group (87.1% vs. 47.7%; log-rank=0.004). Device exchange was associated with improved 1-year survival and fewer cerebrovascular accidents. Surgical intervention, if feasible, is recommended for LVAD device thrombosis. Copyright (c) 2019 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.All authors: Chung B, Jeevanandam V, Kalantari S, Kim G, Kitahara H, Koda Y, Onsager D, Ota T, Raikhelkar J, Sarswat N, Sayer G, Smith B, Song T, Uriel NOriginally published: Artificial Organs. 2019 Oct 29Fiscal year: FY2020Digital Object Identifier:

Date added to catalog: 2019-11-19

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	31660619	Available		31660619

The purpose of this study is to compare clinical outcomes of left ventricular assist device (LVAD) patients with device thrombosis who underwent device exchange or medical therapy alone. Consecutive patients undergoing LVAD implant between 7.2008 and 12.2017 were included. Device thrombosis was diagnosed with comprehensive assessments including ramp test, laboratory data, device parameters, and clinical presentations. Firstly, medical therapy was initiated in all patients. After medical therapy, device exchange was considered if device thrombosis was refractory to initial medical therapy, and it caused end-organ impairment and/or hemodynamic instability. Among 319 consecutive LVAD patients, 43 patients (13.5%) were diagnosed with device thrombosis. Device exchange was performed in 28 patients (DE group), device explant in 1 patient. Medical therapy was continued in 14 patients (MT group). In-hospital mortality was significantly lower in the DE group than the MT group (3.6% (1/28) vs. 28.6% (4/14), p=0.0184). One-year survival was significantly better in the DE group (74.0% vs. 30.1%; log-rank=0.001), and freedom from cerebrovascular accident at 1 year was greater in the DE group (87.1% vs. 47.7%; log-rank=0.004). Device exchange was associated with improved 1-year survival and fewer cerebrovascular accidents. Surgical intervention, if feasible, is recommended for LVAD device thrombosis. Copyright (c) 2019 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

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