Left Ventricular Assist Device Thrombosis: Combined Approach by Echocardiography and Logfiles Review for Diagnosis and Management

Introduction: Left ventricular assist devices are an established therapy for end-stage heart failure. Follow-up of these patients showed complications, such as thrombosis. Our objective was to evaluate the contribution of echocardiography - in association with HeartWare HVAD online logfiles reviews and lactate dehydrogenase titration - for diagnosis and treatment of thrombosis. Methods: Seventeen episodes of thrombosis were diagnosed in 8/20 patients with HVAD. Diagnosis was made by trans-thoracic echocardiographic blood flow velocities, logfiles review of power consumption and pump flows, and titration of lactate dehydrogenase. Data were collected at baseline routine control (Group A), during thrombosis (Group B), after thrombolysis (Group C). Results: Thrombolysis was successful in all cases; one patient died of cerebral haemorrhage. Echocardiographic maximal blood flow velocity near the inflow cannula was 598 +/- 42 cm/sec (Group B), 379.41 +/- 21 cm/sec (Group C), and 378.24 +/- 28 cm/sec (Group A) (P<0.00001). In eight (47%) cases, thrombi were visualized in the left ventricle by three-dimensional modality. Logfiles recordings of blood flows were 9.52 +/- 0.9 L/min (Group B), 4.02 +/- 0.4 L/min (Group C), and 4.04 +/- 0.4 L/min (Group A) (P<00001). Power consumption was 5.01 +/- 0.7 W (Group B), 3.45 +/- 0.2 W (Group C), and 3.46 +/- 0.2 W (Group A) (P<0.00001). Lactate dehydrogenase was 756 +/- 54 IU (Group B), 234 +/- 22 IU (Group A), and 257 +/- 36 IU (Group C) (P<0.00001). Conclusions: Echocardiography of increased maximal velocity near the inflow cannula is a sign of HVAD obstruction. Logfile reviews provide a clear picture of HVAD obstruction. Combination of echocardiographic data and review of logfiles detects signs of left ventricular assist devices thrombosis leading to a successful treatment.