Open AccessPump Position Impacts HeartMate II Left Ventricular Assist Device Thrombosis
Author(s) -
Ahmet Kilic,
John Ransom,
Simon Maltais,
Benjamin Sun,
John Entwistle,
Stephen Bailey,
Ranjit John,
Charles T. Klodell,
Igor D. Gregorič,
Brett C. Sheridan,
Joyce Chuang,
David J. Farrar,
Kartik S. Sundareswaran,
Robert Adamson
Publication year - 2019
Publication title -
asaio journal
Language(s) - Uncategorized
Resource type - Journals
SCImago Journal Rank - 0.961
H-Index - 66
eISSN - 1538-943X
pISSN - 1058-2916
DOI - 10.1097/mat.0000000000000840
Subject(s) - medicine , confidence interval , hazard ratio , cardiology , ventricular assist device , thrombosis , relative risk , prospective cohort study , surgery , heart failure
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.