Abstract
Background and aim: Hemocompatibility of left ventricular assist devices (LVADs) represents one of their main target. Currently, third generation-fully-magnetically-levitated LVAD (HeartMate 3, HM3) has shown high hemocompatibility. Aim of this retrospective study was to evaluate the impact of different antithrombotic strategies in HM3 patients. Methods: Patients were monitored by clinical evaluation, classical laboratory, thromboelastometry (ROTEM) and aggregometry (Multiplate) in the postoperative period and at follow-up. Based on therapeutic options, our population (=25 patients, from November 2015 to March 2018) wad divided in: Group A (=15 patients, 60%) with antiplatelet + anticoagulant medications and Group B (=10 patients, 40%) with anticoagulant medication alone. Primary outcome was freedom from thromboembolic and/or hemorrhagic events. For the assessment of asymptomatic neurologic events, patients were explored with MiniMental-State-Examination (MMSE) and Brief-Neuropsychological-Examination 2 (ENB2). Results: At surgery, mean age was 61.5 ± 5.6 years and 4 patients (16%)were in INTERMACS profile 1, 15 (60%) in profile 2–3 and 6 (24%) in profile 4. Overall 10 patients (Group A = 9, 40% vs Group B = 1, 10%, p = 0.0177) had bleedings. In particular, cerebral hemorrhage in 1 (Group A), gastrointestinal bleeding in 5 (Group A), late onset chest bleeding in 2 (Group A), minor bleeding in 6 (5 Group A, 1 Group B). No thromboembolic events were reported. At follow-up ENB2 showed significant improvement of patients’ neuropsychological performance (p = 0.006), whereas MMSE results remained stable (p = 0.1). Conclusions: Heartmate 3 is a highly hemocompatible device. In our experience, anticoagulation alone is a safe and effective therapy as it prevents both thrombotic and hemorrhagic events.
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