Cavitation in left ventricular assist device patients: a potential early sign of pump thrombosis
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Cavitation in left ventricular assist device patients: a potential early sign of pump thrombosis Marco Zuin 1 & Gianluca Rigatelli 2
&
Gabriele Braggion 3 & Daniela Bacich 4 & Thach Nguyen 5
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Mechanical ventricular support with left ventricular assist device (LVAD) has emerged as a durable and safe therapy, both as bridge-to-transplant (BTT) or destination therapy (DT), in patients with advanced heart failure (HF). However, the occurrence of pump thrombosis (PT) still represents a serious complication, especially when LVADs of first or second generation are implanted. During the latest years, some investigations have recognized the occurrence of cavitation, evidenced through transthoracic echocardiography (TTE), as a potential early and indirect sign of PT. In the present manuscript, we reviewed the available data on the occurrence of cavitation in LVAD patients as an early potential marker of PT, also presenting the hemodynamic mechanisms involved. Keywords Left ventricular assist device . Pump thrombosis . Cavitation . Microbubbles . Echocardiography
Abbreviations BTT Bridge-to-transplant DT Destination therapy HITS High-intensity transient signals LVAD Left ventricular assist device LVEDD Left ventricular end diastolic diameter P Pressure PT Pump thrombosis PV Vapor pressure TCD Transcranial Doppler TTE Transthoracic echocardiography
* Gianluca Rigatelli [email protected] 1
Section of Internal and Cardiopulmonary Medicine, Faculty of Medicine, University of Ferrara, Ferrara, Italy
2
Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
3
Division of Cardiology, Adria General Hospital, Rovigo, Italy
4
Department of Cardiology, Porto Viro Hospital, Porto Viro, Rovigo, Italy
5
Cardiovascular Research, Methodist Hospital, Merrillville, IN, USA
Introduction Left ventricular assist devices (LVADs) has emerged as a durable and safe therapy both as a bridge-to-transplant (BTT) or destination therapy (DT), in patients with severe heart failure (HF) requiring heart transplantation [1–3]. However, despite the significant improvement in device design and clinical management of these patients over the latest years, the rate of LVAD-related adverse events (AEs) still represents a relative frequent issue in clinical practice [3]. In particular, the occurrence of a pump thrombosis (PT), which is generally more frequently experienced by those patients treated with a first- or second-generation device, has a significant impact on the prognosis [4]. As already described, PT may result in catastrophic and life-threatening clinical events, such as a rapid hemodynamic deterioration or embolism, potentially requiring an emergent pump-exchange [5]. In this setting, a multi-imaging approach can be useful to investigate the presence of a LVAD thrombosis, allowing to estimate the severity of the AE and improving its therapeutic management [1]. During the latest years, some investigations have descr
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