Systemic or Endoventricular Thrombolysis to Treat HeartWare Left Ventricle Assist Device Thrombosis: A Clinical Dilemma

Endoventricular thrombolytic procedure ( ETP ) has been used to treat continuous‐flow left ventricle assist device ( CF ‐ LVAD ) thrombosis. The study aims to investigate the occurrence of complications after ETP . Data were retrospectively reviewed and analyzed in a series of patients who underwent CF ‐ LVAD followed by ETP . Since N ovember 2010, 20 patients underwent HeartWare CF ‐L VAD implantation at our institute. Four patients (20%) developed pump thrombosis and underwent a total of nine ETPs with tissue plasminogen activator infused into the left ventricle. The mean age was 60.2 ± 9 years. ETP was performed via either the femoral ( n  = 6) or radial artery ( n  = 3). Five ETPs (55.5%) were complicated by left and right radial artery occlusion, two by groin hematomas, and one by femoral artery false aneurysm. ETP carries a strong risk of vascular access complications that, in CF ‐ LVAD patients, may add to the already complex clinical profile and economic burden; thus, a less invasive treatment is advisable whenever required.