Pump position impacts heartmate II left ventricular assist device thrombosis

Ahmet Kilic, John Ransom, Simon Maltais, Benjamin Sun, John W. Entwistle, Stephen Bailey, Ranjit John, Charles T. Klodell, Igor Gregoric, Brett Sheridan, Joyce Chuang, David J. Farrar, Kartik Sundareswaran, Robert Adamson

Research output: Contribution to journalArticle

Abstract

The PREVENtion of HeartMate II pump Thrombosis through clinical management (PREVENT) study was a multicenter, prospective investigation to evaluate the rate of pump thrombosis (PT) with adoption of a uniform set of surgical and medical practices for left ventricular assist device implantation. We sought to quantify pump position at baseline and retrospectively define a pump position associated with poor clinical outcomes. Chest x-rays at baseline were prospectively obtained per protocol. Pump pocket depth, inflow cannula (IC) angle relative to the pump, and IC angle relative to the vertical were measured. Pumps falling in the tail-ends of the IC angle and pump pocket depth distributions were categorized as having an extreme pump position within the PREVENT study. Patients with extreme pump position had a significantly higher risk of confirmed and suspected PT, hemolysis, and elevated lactate dehydrogenase. In a multivariable analysis of survival free of confirmed PT, extreme pump position was an independent risk factor (hazard ratio = 3.6; 95% confidence interval = 1.5-8.9; p = 0.006) when adjusting for differences in pump speed and anticoagulation level. Our analysis shows that HeartMate II pump position at implant can significantly impact event-free survival and the incidence of adverse events at 6 months.

Original languageEnglish (US)
Pages (from-to)227-232
Number of pages6
JournalASAIO Journal
Volume65
Issue number3
DOIs
StatePublished - Mar 1 2019

Keywords

  • HeartMate II
  • pump position
  • pump thrombosis

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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  • Cite this

    Kilic, A., Ransom, J., Maltais, S., Sun, B., Entwistle, J. W., Bailey, S., John, R., Klodell, C. T., Gregoric, I., Sheridan, B., Chuang, J., Farrar, D. J., Sundareswaran, K., & Adamson, R. (2019). Pump position impacts heartmate II left ventricular assist device thrombosis. ASAIO Journal, 65(3), 227-232. https://doi.org/10.1097/MAT.0000000000000840