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Left ventricular assist device implantation in patients with left ventricular thrombus
Author(s) -
Dogan Günes,
Mariani Silvia,
Hanke Jasmin S.,
Deniz Ezin,
Merzah Ali,
Li Tong,
Haverich Axel,
Schmitto Jan D.
Publication year - 2021
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.13963
Subject(s) - medicine , thrombus , left ventricular thrombus , cardiology , ejection fraction , ventricular assist device , contraindication , thrombosis , magnetic resonance imaging , dilated cardiomyopathy , radiology , heart failure , alternative medicine , pathology
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.