Abstract
Hemolysis is a precursor to pump thrombosis and dysfunction. Not all patients with pump thrombosis are candidates for surgical ‘bailout’ surgery.We present data on HeartMate 2 patients that were successfully medically managed when having hemolysis. Data was collected on 229 HeartMate 2 implants from 2008-2014. We had 52 discrete hemolysis events in 41 unique patients. Hemolysis was defined by LDH >450 u/l and PFH >15mg/dl. Patients were routinely treated with heparin or bivalirudin and aggressive oral and intravenous antiplatelet therapy. Pump dysfunction causing heart failure, LVAD alarms, LV dilation, or nondecompression of LV with ramp study was thought to be pump thrombosis. Non surgical candidates continued with aggressive medical therapy. The hemolysis rate was 0.14 event/patient year supported. The thrombosis rate was 0.08 event/pt. year supported. Hemolysis/Thrombosis event rate ratio was 1.75. There were 41 patients with hemolytic events, with 9 patients having recurrent hemolysis. Median time to hemolysis post implant was 170 days. There were 18 episodes within 90 days and 21 episodes after 365 days post implant. Average LDH was 1599 and average PFH was 106.When computed for death or transplant: there was 1 event every 2.75 pt. support years in the patients without hemolysis v/s 1 event every 2.91 pt.support years (p=ns). Average post hemolysis survival was 0.98 years. Average survival post hemolysis in successfully medically managed patients was 2.14 years compared to patients who were surgically managed. Hemolysis is an ominous event in patients with durable LVADS. Not all hemolysis results in pump replacement, death or transplant. >40% of patients can successfully be treated medically when they develop hemolysis. Approximately 20% of patients develop recurrent hemolysis, but only 20% of those require surgical therapy. Further analysis may help in identifying and risk stratifying low and high risk LVAD patients with hemolysis.
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