TY - JOUR
T1 - Advancements in left ventricular assist devices to prevent pump thrombosis and blood coagulopathy
AU - Malone, Grainne
AU - Abdelsayed, Gerges
AU - Bligh, Fianait
AU - Al Qattan, Fatma
AU - Syed, Saifullah
AU - Varatharajullu, Prateepan
AU - Msellati, Augustin
AU - Mwipatayi, Daniela
AU - Azhar, Maimoona
AU - Malone, Andrew
AU - Fatimi, Saulat H.
AU - Conway, Claire
AU - Hameed, Aamir
N1 - Funding Information:
We would like to acknowledge School of Pharmacy and Biomolecular Sciences, who supported this project as part of MPharm - Year 4 Scientific Research Skills (SRS) module. We would also like to acknowledge the RCSI Research Summer School (RSS), which provides medical students with the opportunity to become involved in research projects during the summer months. Open access funding provided by IReL. [Correction added on 15 May 2022, after first online publication: IReL funding statement has been added.]
Publisher Copyright:
© 2022 The Authors. Journal of Anatomy published by John Wiley & Sons Ltd on behalf of Anatomical Society.
PY - 2023/1
Y1 - 2023/1
N2 - Mechanical circulatory support (MCS) devices, such as left ventricular assist devices (LVADs) are very useful in improving outcomes in patients with advanced-stage heart failure. Despite recent advances in LVAD development, pump thrombosis is one of the most severe adverse events caused by LVADs. The contact of blood with artificial materials of LVAD pumps and cannulas triggers the coagulation cascade. Heat spots, for example, produced by mechanical bearings are often subjected to thrombus build-up when low-flow situations impair washout and thus the necessary cooling does not happen. The formation of thrombus in an LVAD may compromise its function, causing a drop in flow and pumping power leading to failure of the LVAD, if left unattended. If a clot becomes dislodged and circulates in the bloodstream, it may disturb the flow or occlude the blood vessels in vital organs and cause internal damage that could be fatal, for example, ischemic stroke. That is why patients with LVADs are on anti-coagulant medication. However, the anti-coagulants can cause a set of issues for the patient—an example of gastrointestinal (GI) bleeding is given in illustration. On account of this, these devices are only used as a last resort in clinical practice. It is, therefore, necessary to develop devices with better mechanics of blood flow, performance and hemocompatibility. This paper discusses the development of LVADs through landmark clinical trials in detail and describes the evolution of device design to reduce the risk of pump thrombosis and achieve better hemocompatibility. Whilst driveline infection, right heart failure and arrhythmias have been recognised as LVAD-related complications, this paper focuses on complications related to pump thrombosis, especially blood coagulopathy in detail and potential strategies to mitigate this complication. Furthermore, it also discusses the LVAD implantation techniques and their anatomical challenges.
AB - Mechanical circulatory support (MCS) devices, such as left ventricular assist devices (LVADs) are very useful in improving outcomes in patients with advanced-stage heart failure. Despite recent advances in LVAD development, pump thrombosis is one of the most severe adverse events caused by LVADs. The contact of blood with artificial materials of LVAD pumps and cannulas triggers the coagulation cascade. Heat spots, for example, produced by mechanical bearings are often subjected to thrombus build-up when low-flow situations impair washout and thus the necessary cooling does not happen. The formation of thrombus in an LVAD may compromise its function, causing a drop in flow and pumping power leading to failure of the LVAD, if left unattended. If a clot becomes dislodged and circulates in the bloodstream, it may disturb the flow or occlude the blood vessels in vital organs and cause internal damage that could be fatal, for example, ischemic stroke. That is why patients with LVADs are on anti-coagulant medication. However, the anti-coagulants can cause a set of issues for the patient—an example of gastrointestinal (GI) bleeding is given in illustration. On account of this, these devices are only used as a last resort in clinical practice. It is, therefore, necessary to develop devices with better mechanics of blood flow, performance and hemocompatibility. This paper discusses the development of LVADs through landmark clinical trials in detail and describes the evolution of device design to reduce the risk of pump thrombosis and achieve better hemocompatibility. Whilst driveline infection, right heart failure and arrhythmias have been recognised as LVAD-related complications, this paper focuses on complications related to pump thrombosis, especially blood coagulopathy in detail and potential strategies to mitigate this complication. Furthermore, it also discusses the LVAD implantation techniques and their anatomical challenges.
KW - blood coagulopathy
KW - heart failure
KW - left ventricular assist devices
KW - mechanical circulatory support
KW - pump thrombosis
KW - thrombus
UR - http://www.scopus.com/inward/record.url?scp=85128420722&partnerID=8YFLogxK
U2 - 10.1111/joa.13675
DO - 10.1111/joa.13675
M3 - Review article
AN - SCOPUS:85128420722
SN - 0021-8782
VL - 242
SP - 29
EP - 49
JO - Journal of Anatomy
JF - Journal of Anatomy
IS - 1
ER -