Pumpenthrombosen

Background

Pump thromboses are a frequent complication after implantation of a left ventricular assist device (LVAD) with an incidence of 10%.

Objective

Evaluation of the risk factors and the necessary diagnostic tools, such as imaging investigations, determination of laboratory parameters and device settings. Recommendations for therapy and differentiation between pharmaceutical and surgical therapy.

Material and methods

A literature search of PubMed and inclusion of own hospital recommendations for actions.

Results

The diagnostics of a pump thrombosis are carried out by extraction of the data stored by the LVAD and are necessary to evaluate an increased pump performance. An increased lactate dehydrogenase 2.5 fold higher than normal values is highly suspicious of a pump thrombosis. For imaging investigations echocardiography provides indirect parameters, such as increased left ventricular end-diastolic diameter (LVEDD) and progressive mitral valve regurgitation, a frequent opening of the aortic valve and the flow velocity in the outflow cannula. A computed tomography (CT) scan can be used to detect a thrombus formation in the outflow cannula. Therapy can be carried out pharmaceutically using thrombolytic agents, such as recombinant tissue type plasminogen activator (rt-PA) or by a surgical replacement of the pump.

Conclusion

The identification of a pump thrombosis is determined by the inclusion of various parameters. The therapy should be carried out individually and be device-specific.