(653) - Early Identification of Impending LVAD Thrombosis Utilizing an Ultra-High Predictive Serum Marker in Lactate Dehydrogenase

Abstract

PurposeA critical adverse event in LVAD implantation is pump thrombosis. Late identification of thrombosis based on parameters such as heart failure, LVAD power elevation, and plasma free hemoglobin is associated with high morbidity and mortality. To address this, a marker for early diagnosis is critical. Therefore, the goal of this study is to develop a predictive tool for early recognition of impending thrombosis to enhance medical and surgical intervention and improve patient outcomes.MethodsWe retrospectively analyzed all continuous flow LVADs, placed between 2011- 2013 at a single center (n=88). We focused analysis on lactate dehydrogenase (LDH) levels at several post-operative time intervals including one week, one month and peak value in relation to pump power. Changes in LDH are reported as ratios between time points. 12 patients underwent pump exchange with confirmation of LVAD thrombosis. The 76 patients without LVAD thrombosis functioned as a control.ResultsPreoperative characteristics between the non-thrombotic and thrombotic groups included sex (15.5% female vs. 16.7% female), age (58.7 ± 1.6 yr vs. 55.5 ± 3.9 yr), diabetes (49.3% vs. 33.0%), and chronic kidney disease (29.6% vs. 25.0%), which were not significantly different. Analysis of patients’ ratio of post-op 1 month LDH : post-op 1 week LDH revealed a significant increase in the thrombotic group (Figure). Additionally, ratios of peak LDH level : post-op 1 week LDH and post-op 1 month were significantly increased in the thrombotic group compared to non-thrombotic (Figure). There was no difference in LVAD power ratio of post-op 1 month : post-op 1 week between the non-thrombotic and thrombotic groups (0.99 ± 0.01 vs. 0.98 ± 0.02, p >0.5).Conclusion PurposeA critical adverse event in LVAD implantation is pump thrombosis. Late identification of thrombosis based on parameters such as heart failure, LVAD power elevation, and plasma free hemoglobin is associated with high morbidity and mortality. To address this, a marker for early diagnosis is critical. Therefore, the goal of this study is to develop a predictive tool for early recognition of impending thrombosis to enhance medical and surgical intervention and improve patient outcomes. A critical adverse event in LVAD implantation is pump thrombosis. Late identification of thrombosis based on parameters such as heart failure, LVAD power elevation, and plasma free hemoglobin is associated with high morbidity and mortality. To address this, a marker for early diagnosis is critical. Therefore, the goal of this study is to develop a predictive tool for early recognition of impending thrombosis to enhance medical and surgical intervention and improve patient outcomes. MethodsWe retrospectively analyzed all continuous flow LVADs, placed between 2011- 2013 at a single center (n=88). We focused analysis on lactate dehydrogenase (LDH) levels at several post-operative time intervals including one week, one month and peak value in relation to pump power. Changes in LDH are reported as ratios between time points. 12 patients underwent pump exchange with confirmation of LVAD thrombosis. The 76 patients without LVAD thrombosis functioned as a control. We retrospectively analyzed all continuous flow LVADs, placed between 2011- 2013 at a single center (n=88). We focused analysis on lactate dehydrogenase (LDH) levels at several post-operative time intervals including one week, one month and peak value in relation to pump power. Changes in LDH are reported as ratios between time points. 12 patients underwent pump exchange with confirmation of LVAD thrombosis. The 76 patients without LVAD thrombosis functioned as a control. ResultsPreoperative characteristics between the non-thrombotic and thrombotic groups included sex (15.5% female vs. 16.7% female), age (58.7 ± 1.6 yr vs. 55.5 ± 3.9 yr), diabetes (49.3% vs. 33.0%), and chronic kidney disease (29.6% vs. 25.0%), which were not significantly different. Analysis of patients’ ratio of post-op 1 month LDH : post-op 1 week LDH revealed a significant increase in the thrombotic group (Figure). Additionally, ratios of peak LDH level : post-op 1 week LDH and post-op 1 month were significantly increased in the thrombotic group compared to non-thrombotic (Figure). There was no difference in LVAD power ratio of post-op 1 month : post-op 1 week between the non-thrombotic and thrombotic groups (0.99 ± 0.01 vs. 0.98 ± 0.02, p >0.5). Preoperative characteristics between the non-thrombotic and thrombotic groups included sex (15.5% female vs. 16.7% female), age (58.7 ± 1.6 yr vs. 55.5 ± 3.9 yr), diabetes (49.3% vs. 33.0%), and chronic kidney disease (29.6% vs. 25.0%), which were not significantly different. Analysis of patients’ ratio of post-op 1 month LDH : post-op 1 week LDH revealed a significant increase in the thrombotic group (Figure). Additionally, ratios of peak LDH level : post-op 1 week LDH and post-op 1 month were significantly increased in the thrombotic group compared to non-thrombotic (Figure). There was no difference in LVAD power ratio of post-op 1 month : post-op 1 week between the non-thrombotic and thrombotic groups (0.99 ± 0.01 vs. 0.98 ± 0.02, p >0.5). Conclusion